Circumcision in patients with bleeding disorders: Can it be done safely?

Abstract

Purpose: The purpose of our study was to review outcome of circumcision among children with bleeding disorders at our institution and also to determine the impact of optimization leading to safe circumcision. Methods: Data representing boys (age 0-16 years) who underwent routine circumcision at the Aga Khan University Hospital (AKUH) between1988-2014 was retrospectively reviewed. Children with bleeding disorder were identified using International Classification of Diseases (ICD) Code 64.0. Data was retrieved and confidentially was maintained. SPSS version 19 was used for statistical analysis. Results: During 26 years 13,200 circumcisions were performed at AKUH. Amongst these 8,463 (64.11%) were done by using Plastibell, while 4,737 (35.88%) by open slit method. Only 23 (0.17%) children were identified with bleeding disorder. Two groups were made, Group-A (n:15) children with known bleeding disorders having circumcision and Group- B, (n:8) those in whom bleeding disorder was diagnosed after circumcision. Median age of children in Group-A was 9 years. All children in Group-A underwent open circumcision. 10 patients had Factor VIII deficiency, 2 had Glanzmann’s thrombasthenia, 1 had Factor IX deficiency, 1 had Quebec platelet disorder, and 1 had Von Willebrand disorder. Median age of children in Group-B was 3 months. 7 out of 8 underwent plastibell while one had circumcision by open technique. 7 were diagnosed as Factor VIII deficiency and 1 diagnosed later to have Glanzmann's thrombasthenia. Statistical analysis showed significant difference among these two groups’ p-value with respect to age (p-value 0.00) and family history (p-value 0.04- Fisher’s exact test). Both groups had similar postoperative length of stay. Overall bleeding complication rate after optimization was 13.33%. Conclusion: With the help of hematologist and adequate Factor replacement, these children can be managed as daycare. We suggest risks and benefit should be discussed with parents before procedure.