WOFAPS 2025 8th World Congress of Pediatric Surgery

Samia Belhassen ¹, Afef Toumi ¹, Sana Mosbahi ¹, Syrine Laribi ¹, Marwa Messaoud ¹, Amine Ksia ¹, Mongi Mekki ¹, Sawsen Chakroun ², Maha Ben Mansour ², Mohsen Belghith ¹, Lassaad Sahnoun ¹

¹ Pediatric surgery department, Fattouma Bourguiba Hospital.
² Pediatric anaesthesia and intensive care department, Fattouma Bourguiba Hospital, Monastir, Tunisia

Background
Although circumcision is one of the most frequently performed surgical procedures worldwide, it is often perceived as a minor or routine intervention. However, like any surgical act, it carries a risk of significant complications. In many regions, cultural and religious practices lead to circumcisions being performed by untrained individuals under non-sterile conditions, often disregarding basic anatomical and aseptic principles. As a result, adverse outcomes remain prevalent.

Objective
To analyze the epidemiological, clinical, and therapeutic aspects of circumcision-related complications and emphasize the importance of recognizing this procedure as a true surgical act requiring appropriate expertise and environment.

Methods
This is a retrospective study conducted in the Department of Pediatric Surgery at Fattouma Bourguiba University Hospital in Monastir, Tunisia. Over a 36-year period (1984–2023), 71 cases of circumcision-related complications were reviewed.

Results
The mean age of the patients was 2.5 years. Circumcisions were performed by traditional practitioners in 20 cases, nurses in 33 cases, physicians in 15 cases, and were unspecified in 3 cases. Complications included partial or total glans amputation in 10 cases (including 1 complete penile amputation and 4 complete glans amputations), bleeding in 22 cases among them 3 needed blood transfusion, local infection in 21 cases, urethrocutaneous fistula in 8 cases, meatal stenosis in 5 cases, and 5 cases of unrecognized hypospadias where circumcision was performed before planned urethroplasty. All amputations required surgical intervention, employing various reconstructive techniques with variable outcomes. Other treatments included meatoplasty, fistula repair, meatotomy, and mucosal bridge excision, with generally satisfactory results.

Conclusion :
Circumcision complications can have serious functional and even life-threatening consequences. This underscores the need to treat circumcision as a true surgical procedure that must be performed under sterile conditions by qualified and licensed healthcare professionals in a medical setting.