Plastibell Infant Circumcision Without Frenulectomy
Plastibell circumcision in infants can be safely performed without frenulectomy, as the standard technique does not routinely include frenulum removal and has demonstrated excellent safety outcomes when performed by experienced practitioners. 1, 2, 3
Standard Plastibell Technique
The Plastibell method is a well-established circumcision technique that does not require frenulectomy as part of the standard procedure:
The technique involves placing a plastic bell over the glans, ligating the foreskin over the bell, and excising the redundant tissue - the frenulum is typically preserved during this process 2, 3
Large multi-center studies demonstrate overall complication rates of only 1.1-2.3% with the standard Plastibell technique, indicating that frenulectomy is not necessary for safe outcomes 1, 3
The procedure should be performed by surgically experienced personnel, as complications increase eight-fold when performed by less experienced practitioners compared to surgeons 1
Safety Profile Without Frenulectomy
The evidence strongly supports omitting frenulectomy:
In a series of 2,276 infant Plastibell circumcisions performed without routine frenulectomy, the complication rate was only 1.1%, with postoperative bleeding being the most common issue (48% of complications) 3
A study of 364 infants showed that adhesions of foreskin to glans occurred in only 0.82% of cases without frenulectomy, demonstrating that preserving the frenulum does not significantly increase adhesion risk 2
The mean time for ring separation is 6-7.8 days, and this is not affected by whether frenulectomy is performed 2, 3
Key Technical Considerations
To optimize outcomes without frenulectomy:
Detailed attention to ligature placement and selection of appropriate Plastibell size are the critical factors for preventing complications, not frenulum removal 3
The procedure should be performed under adequate local anesthesia - topical anesthesia for 90 minutes to the penis is standard 3
Adequate parental education about post-procedure care is essential to prevent mishaps 3
Post-Procedure Management
Standard care after Plastibell circumcision without frenulectomy:
Implement daily gentle retraction of penile skin with petroleum-based ointment application to prevent adhesions 4
Cleanse gently with water only during the first week - avoid soaps and irritants 4
Monitor for bleeding, pain, erythema, or signs of infection with each diaper change 4
Schedule reassessment at 3 weeks post-procedure to evaluate healing 4
Common Pitfalls to Avoid
Do not perform unnecessary frenulectomy - it adds no benefit to the standard Plastibell technique and may increase bleeding risk 1, 2, 3
Ensure the procedure is performed by appropriately trained specialists - the American Academy of Pediatrics emphasizes that pediatric urologic procedures should be performed by appropriately trained specialists 5
Avoid using occlusive dressings as these promote moisture and can lead to skin maceration and infection 4