Safer circumcision in patients with haemophilia: the use of fibrin glue for local haemostasis

Objective To evaluate the efficacy and the reduced costs of factor concentr ates in circumcision by using fibrin glue in patients with haemophilia. Patients and methods Eleven patients with haemophilia (age range 6-14 years , 10 with haemophilia A, one with haemophilia B) were circumcised using fib rin glue for local haemostasis and to reduce the duration of clotting facto r replacement after surgery. Circumcision was carried out under general ana esthesia; the prepuce was incised circumferentially and excised using the G omco cramp technique. Haemophiliac patients were divided into two groups: i n group 1 (four patients, three with haemophilia A and one with haemophilia B) the factor levels were assessed every 8 h and bolus injections of facto r repeated during the first 4 days after surgery; in group 2, the seven rem aining haemophilia a patients received a postoperative bolus injection and approximate to 4 U/kg per hour of factor substitution for the first 2 days after surgery by continuous infusion, Eleven other patients with haemophili a A underwent circumcision using same surgical procedure but were given onl y factor substitution without fibrin glue, and served as a control group (g roup 3). Results None of the patients had significant bleeding or complications. The total costs were significantly reduced, to $8898 per patient in group 1 an d $4866 per patient in group 2, when compared with $12875 per patient in gr oup 3 (both P<0.05). Conclusion Fibrin glue is a useful treatment for circumcision in patients w ith haemophilia: it lessens the need for factor substitution after circumci sion and thus reduces the high cost of treatment.