@Article{,
AUTHOR = {Maria Voznesensky, Christopher Mutter, Matthew Hayn, 
Thomas Kinkead, Brian Jumper},
TITLE = {Pediatric sutureless circumcision: an effective and cost efficient alternative},
JOURNAL = {Canadian Journal of Urology},
VOLUME = {22},
YEAR = {2015},
NUMBER = {5},
PAGES = {7995--7999},
URL = {http://www.techscience.com/CJU/v22n5/61224},
ISSN = {1488-5581},
ABSTRACT = {<b>Introduction:</b> Circumcision is the most commonly 
performed surgical procedures in male children. Maine 
is one of 18 states in the United States which does not 
pay for neonatal circumcisions. <br/>
The aim of this study was to perform outcomes and cost 
analysis of a sutureless circumcision technique versus 
circumcision using sutures. Specifically, we evaluated 
Dermaflex (2-octyl cyanoacrylate, 2-OCA) surgical glue 
circumcision as a cost effective, faster, and safe alternative 
to traditional suture circumcision.<br/>
<b>Materials and methods: </b>Our study was a nonrandomized series. We collected the operative details 
prospectively, abstracted clinical outcomes retrospectively, 
and performed data analysis retrospectively. One 
hundred and twenty-six circumcisions were performed 
by two pediatric urologists over a 1 year period. Suture 
circumcisions were performed exclusively during the 
first 6 months, and 2-OCA glue circumcisions were 
performed during the second 6 months. Billing charges 
were analyzed to extrapolate variable costs between the 
two surgical procedures. <br/>
The technique used to perform the sutureless circumcision 
was a modification of the standard sleeve technique, with 
the use of monopolar diathermy instead of scalpel, and 
application of 2-OCA glue to approximate tissue edges. <br/>
<b>Results: </b>From Jan 2013 to Jan 2014, 72 patients 
underwent circumcision with suture, and 54 patients 
underwent circumcision with 2-OCA glue. Mean age 
in the glue group was 61 months (range 8-202 months), 
and 50 months in the suture group (range 5-215 months), 
p = 0.19. All cases were performed under general 
anesthesia, as outpatient surgery. Mean operative cut 
time was 18.4 min for the glue group, and 28.6 min for 
the suture group (p < 0.01). The 10.2 min operative 
time difference translated to a $378 cost savings per 
glue circumcision case. Complication rates were not 
statistically significant between the two groups. <br/>
<b>Conclusion:</b> The use of 2-OCA tissue adhesive for 
sutureless circumcision is an alternative to the standard 
technique. It results in faster operative times, with a 
significant cost savings, while maintaining comparable 
complication rates to the standard suture technique. This 
is a viable, less expensive surgical option for patients 
whose circumcisions are not covered by Medicaid.},
DOI = {}
}