Circumcision – The Procedure Techniques

Dorsal Slit Technique

This technique is preferred for use in patients with phimosis or paraphimosis. In the patient presenting with acute paraphimosis, gentle, steady pressure on the prepuce decreases the swelling. The physician may then reduce the paraphimosis by pushing on the glans with the thumbs and pulling on the foreskin with the fingers. If this step is unsuccessful, the dorsal slit can be performed to relieve the pain, and the remainder of the circumcision can be performed at a later time.

To perform the dorsal slit, the physician needs to identify the corona of the glans and determine the extent of the dorsal slit. This is the most important step in removing the correct amount of prepuce. The slit should extend from the meatal opening 75 percent of the distance to the corona. Counter-traction on the edges of the foreskin while the physician makes the slit with scissors is helpful. The preputial skin should then be held perpendicular from the shaft of the penis and excised at its base with scissors. Large superficial veins are then ligated.

The frenulum is reapproximated first, as it can be a site of problematic bleeding. We prefer to use a subcutaneous “U” stitch for good cosmesis and to help avoid bleeding. The cut edges of the foreskin are closed with multiple simple interrupted stitches using 4-0 or 5-0 absorbable sutures (chromic: Dexon or Vicryl) spaced evenly every 4 to 7 mm. Excess bleeding is controlled with direct pressure and electrocautery. A sterile dressing of petroleum gauze can then be applied over the sutures.