Circumcision with Plastibell
Plastibell is a device composed a plastic "bell-like' shape and a string to ligate the foreskin around the cup of the plastibell.
The Plastibell is manufactured by the Hollister Company. It comes in a sterile package with various sizes. It can be used for infants up to 10-12 years old child.

It is composed of handle, cup and string. The cup has groove around its outer surfaces. This is where the string would be ligated.

As with most other devices, choosing the correct size is important. Too small size may cause pressure necrosis and injury to the glans penis. If the cup is too big, then it may slip off easily from its tied position and cause skin loss.

Typically a dorsal slit is made to allow the insertion of the plastibell. The string can be ligated loosely first prior to the insertion or ligated after the plastibell inserted fully around the glans. After ligation is secured, remove the excess skin with scalpel or scissors. The handle of the Plastibell is then snapped off.

The procedure is complete. When there is no bleeding, the baby can be discharged home.

The rim of tissue distal to the ligature becomes necrotic and the
Plastibell drops off after 5 - 8 days. Alternatively the infant can be checked after 36 to 48 hours and the ligature cut.

After circumcision care:

Parental Education:

1. Wound care:

Normal washing and bath may use lubricant such as petroleum jelly or antibiotic ointment to prevent the wound from direct contact with diaper.

2. Pain relieves:

Newborn child may not require any pain medicine. However the elder child may be given some pain killers such as paracetamol or ponstan.

3. Complications:

Healing is usually complete after about one week.
Bleeding is rare because the clamp crushes the foreskin edge.

Other complications include bleeding, infection, early separation, or slippage. If the ring slips behind the glans, it can result in venous congestion and necrosis.

The parents should be told to come back to the clinic if any of the following occurs:
o The child appears to be distressed or in pain
o Fever
o Not waking for feeding as per usual pattern
o Any separation of the skin edges
o Any unusual swelling or bleeding
o Any difficulties with urination
o The plastic ring has slipped onto the shaft of the penis
o One part of the foreskin remains pink or has not shriveled after 48 hrs
o The plastic ring has not fallen off within 8 days
o Any other worry about healing.

A more complete procedure can be found at :
http://www.circlist.com/instrstechs/plastibell.html
http://www.infocirc.org/plasti.htm
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