Gomco circumcision: When is it safe?

Background/Purpose: The Gomco clamp is used most commonly for neonatal circ umcisions in the United States with reported rates of complication as low a s 0.2%. Often, however, circumcision is delayed beyond the neonatal period because of illness, parental concerns, or physician bias with patients pres enting for elective circumcision in the first few years of life. In neonate s and infants, the "bloodless" Gomco circumcision is cost effective, can be performed with minimal anesthesia and gives good cosmetic results. However , the optimal age at which to perform this procedure remains controversial. We reviewed the experience of one pediatric urologist with Gomco circumcis ion in neonates and infants to determine the optimal age at which this proc edure should be performed. Methods: One hundred thirty patients underwent Gomco circumcision by 1 pedi atric urologist between 1996 and 1998. Ninety-eight patients underwent Gomc o circumcision as neonates or during early infancy at a mean age of 17 days (range, 4 to 30 days). Thirty-two patients underwent circumcision after ea rly infancy at a mean age of 6.5 months (range, 90 days to 8.5 months). All patients younger than 1 month of age underwent circumcision while fully aw ake using a dorsal penile nerve block. Patients greater than 3 months of ag e were circumcised under general anesthesia. Gomco circumcision was perform ed using 1.1- to 2.1-cm bells. Patients were assessed with regard to outcom e. Results: None of the 98 patients in the early infancy group had postcircumc ision complications. Of the 32 patients in the older group, 12 (30%) had po stoperative bleeding requiring suture repair or fulguration. The skin edges separated in 2 patients, 1 less than 1 month of age and 1 in the older gro up. Neither patient required further intervention, and both healed spontane ously. There was no correlation between size of clamp and development of co mplications. Conclusion: Although safe and effective for circumcision in the neonatal pe riod and in early infancy, use of the Gomco clamp for circumcision beyond e arly infancy (3 months of age) has substantial morbidity, and alternative m ethods of circumcision should be sought. Copyright (C) 2001 by W.B. Saunder s Company.