Paediatric Surgery (Ukraine). 2026. 1(90): 82-87. doi: 10.15574/PS.2026.1(90).8287
Alhasani A. A.
College of Medicine, University of Basrah, Basra, Iraq

For citation: Alhasani AA. (2026). Assessment of Plastibell device safety for circumcision in iraq: a retrospective study. Paediatric Surgery (Ukraine). 1(90): 82-87. doi: 10.15574/PS.2026.1(90).8287
Стаття надійшла до редакції 11.02.2026 р., прийнята до друку 16.03.2026 р.
Article received: Feb 11, 2026. Accepted for publication: Mar 16, 2026.

The Plastibell^® device is the most commonly used technique for routine male circumcision all over the globe.
Aim – to assess the Plastibell^® device utilization safety for circumcision procedures in Iraq, its applicability across different age groups, and the incidence of associated complications.
Materials and methods. This is a retrospective study involving children who underwent circumcision using Plastibell^® devices at the pediatric surgery clinic in Al Moosawi Private Hospital. The study was extended for 11 years and included 2041 boys. Three age groups were studied: neonates, infants 1-3 months old, and those older than three months.
Results. In the cohort of 2041 children, the mean age was 38.65 days (range 1 day to 3.5 years). The majority of participants were neonates (72.7%), followed by infants aged 1-3 months (19.5%) and older infants (> 3 months, 7.8%). Most cases originated from Basrah city center (56.1%), followed by peripheral districts (43.2%) and other governorates (0.7%). Complications were encountered in 3.6% of cases, with bleeding being the most prevalent (1.4%), followed by delayed ring separation (1.1%), incomplete circumcision (0.7%), proximal ring migration (0.2%), and infection (0.2%). A significant association between age and complication rates was found, with older infants experiencing higher rates of complications compared to neonates and infants aged 1-3 months. Six patients (0.29%) were reported to have incomplete circumcision.
Conclusion. This study underscores the safety of circumcision using Plastibell^® rings in children, with minor complications being easily manageable. However, clinicians should be vigilant, particularly when performing the procedure in older infants, as they are at higher risk of experiencing complications.
The study was performed in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the work.
The author declares no conflict of interest.
Keywords: Plastibell, neonate, circumcision, surgical safety, infants.

REFERENCES

1. American Academy of Pediatrics Task Force on Circumcision. (2012). Circumcision policy statement. Pediatrics. 130(3): 585-586. https://doi.org/10.1542/peds.2012-1990; PMid:22926175

2. Bliss DP Jr, Healey PJ, Waldhausen JHT. (1998). Necrotizing fasciitis after Plastibell circumcision. J Urol. 159(4): 1408. https://doi.org/10.1016/S0022-5347(01)63646-2

3. Christakis DA, Harvey E, Zerr DM, Feudtner C, Wright JA, Connell FA. (2000). A trade-off analysis of routine newborn circumcision. Pediatrics. 105; Suppl 2: 246-249. PMID: 10617731. https://doi.org/10.1542/peds.105.S2.246

4. Dabbagh H. (2022). Is circumcision necessary in Islam? J Relig Health. 61(6): 4871-4886. https://doi.org/10.1007/s10943-022-01635-0; PMid:36006531 PMCid:PMC9569283

5. Davis SM, Bailey RC. (2022). Can the ShangRing bring us closer to endorsing early infant male circumcision? Lancet Glob Health. 10(10): e1377-e1378. https://doi.org/10.1016/S2214-109X(22)00380-1; PMid:36113516

6. Drain PK, Halperin DT, Hughes JP, Klausner JD, Bailey RC. (2006). Male circumcision, religion, and infectious diseases: an ecologic analysis of 118 developing countries. BMC Infect Dis. 6: 172. https://doi.org/10.1186/1471-2334-6-172; PMid:17137513 PMCid:PMC1764746

7. Duncan ND, Dundas SE, Brown B, Pinnock-Ramsaran C, Badal G. (2004, Jan). Newborn circumcision using the Plastibell device: an audit of practice. West Indian Med J. 53(1): 23-26. PMID: 15114889.

8. Freedman A, Lerman SE, Bergman J. (2012). Complications of circumcision. In: Surgical Guide to Circumcision: 45-57. https://doi.org/10.1007/978-1-4471-2858-8_6

9. Frisch M, Earp BD. (2018). Circumcision of male infants and children as a public health measure in developed countries: a critical assessment of recent evidence. Glob Public Health. 13(5): 626-641. https://doi.org/10.1080/17441692.2016.1184292; PMid:27194404

10. Hamza BK, Ahmed M, Bello A et al (2020). Comparison of the efficacy and safety of circumcision by freehand technique and Plastibell device in children. Afr J Urol. 26(66):1-6. https://doi.org/10.1186/s12301-020-00076-z

11. Javed A, Mumtaz H, Ambreen S et al. (2022). Comparison of duration of surgery: dissection vs plastibell. Pak Biomed J. 5(1): 108-111. https://doi.org/10.54393/pbmj.v5i1.168

12. Jimoh BM, Odunayo IS, Chinwe I, Akinfolarin OO, Oluwafemi A, Olusanmi EJ. (2016, Feb 9). Plastibell circumcision of 2,276 male infants: a multi-centre study. Pan Afr Med J. 23: 35. PMID: 27200140; PMCID: PMC4856486. https://doi.org/10.11604/pamj.2016.23.35.7841

13. Kalyanaraman M, McQueen D, Sykes J et al. (2015). Urosepsis and renal failure after Plastibell circumcision. Korean J Pediatr. 58(4): 154-156. https://doi.org/10.3345/kjp.2015.58.4.154; PMid:25932038 PMCid:PMC4414631

14. Krill AJ, Palmer LS, Palmer JS. (2011). Complications of circumcision. Sci World J. 11: 2458-2468. https://doi.org/10.1100/2011/373829; PMid:22235177 PMCid:PMC3253617

15. Labban M, Menhem Z, Bandali T, Hneiny L, Zaghal A. (2021, Feb). Pain control in neonatal male circumcision: A best evidence review. J Pediatr Urol. 17(1): 3-8. https://doi.org/10.1016/j.jpurol.2020.09.017; PMid:33036929

16. Mavhu W, Larke N, Hatzold K, Ncube G, Weiss HA, Mangenah C et al. (2016, Jul 13). Safety, Acceptability, and Feasibility of Early Infant Male Circumcision Conducted by Nurse-Midwives Using the AccuCirc Device: Results of a Field Study in Zimbabwe. Glob Health Sci Pract. 4; Suppl 1: S42-54. https://doi.org/10.9745/GHSP-D-15-00199; PMid:27413083 PMCid:PMC4944579

17. Moosa FA, Khan FW, Rao MH. (2010, Aug). Comparison of complications of circumcision by 'Plastibell device technique' in male neonates and infants. J Pak Med Assoc. 60(8): 664-667. PMID: 20726200.

18. Morris BJ. Neonatal urinary tract infections. (details incomplete; doi not available).

19. Mousavi SA, Salehifar E. (2008). Circumcision complications associated with the Plastibell device and conventional dissection surgery: a trial of 586 infants of ages up to 12 months. Adv Urol. 2008: 606123. Epub 2008 Nov 4. https://doi.org/10.1155/2008/606123; PMid:19009030 PMCid:PMC2581731

20. Munzer SR. (2018). Examining nontherapeutic circumcision. Health Matrix. 28: 1. URL: https://philarchive.org/archive/MUNDRP.

21. Nabavizadeh B, Li KD, Hakam N, Shaw NM, Leapman MS, Breyer BN. (2022). Incidence of circumcision among insured adults in the United States. PLoS One. 17(10): e0275207. https://doi.org/10.1371/journal.pone.0275207; PMid:36251658 PMCid:PMC9576047

22. Naudé JA. (2022). Emergence of the Tyndale – King James Version tradition in English Bible translation. HTS Teologiese Studies/Theological Studies. 78(1): a7649. https://doi.org/10.4102/hts.v78i1.7649

23. Nayir A. (2001). Circumcision for the prevention of significant bacteriuria in boys. Pediatr Nephrol. 16: 1129-1134. https://doi.org/10.1007/s004670100026

24. Okeke LI, Asinobi AA, Ikuerowo OS. (2006). Epidemiology of complications of male circumcision. BMC Urol. 6: 7. https://doi.org/10.1186/1471-2490-6-7; PMid:16539730 PMCid:PMC1435920

25. Peng YF, Cheng Y, Wang GY et al. (2008). Clinical application of a new device for minimally invasive circumcision. Asian J Androl. 10(3): 447-454. https://doi.org/10.1111/j.1745-7262.2008.00353.x; PMid:18097516

26. Peterson AC, Joyner BD, Allen RC Jr. (2001). Plastibell template circumcision. Urology. 58(4): 603-604. https://doi.org/10.1016/S0090-4295(01)01330-9

27. Razzaq S, Mehmood MS, Tahir TH, Masood T, Ghaffar S. (2018, Sep-Oct). Safety of the plastibell circumcision in neonates, infants, and older children. Int J Health Sci (Qassim). 12(5): 10-13. PMID: 30202402; PMCID: PMC6124829.

28. Refaat DO, Tantawy IM, Mokhtar MM et al. (2023). Circumcision in neonates and infants using different techniques. Egypt J Hosp Med. 90(2): 2662-2669. https://doi.org/10.21608/ejhm.2023.286424

29. Samad A, Khanzada TW, Kumar B. (2010). Plastibell circumcision. J Pediatr Urol. 6(1): 28-31. https://doi.org/10.1016/j.jpurol.2009.02.006

30. Shabbir M, Hughes B, Watkin N. (2009). Penile cancer and associated dermatoses. In: Men's Health. Boca Raton: CRC Press: 98-105. https://doi.org/10.3109/9781439808078-12

31. Simforoosh N, Tabibi A, Khalili SAR et al. (2012). Neonatal circumcision reduces the incidence of asymptomatic urinary tract infection. J Pediatr Urol. 8(3): 320-323. https://doi.org/10.1016/j.jpurol.2011.05.009

32. Weiss HA, Larke N, Halperin D, Schenker I. (2010, Feb 16). Complications of circumcision in male neonates, infants and children: a systematic review. BMC Urol. 10: 2. https://doi.org/10.1186/1471-2490-10-2; PMid:20158883 PMCid:PMC2835667

33. WHO. (2008). Male circumcision: global trends and determinants of prevalence, safety and acceptability. Geneva: World Health Organization.

34. Wu X, Wang Y, Zheng J, Shen W, Yan JA, Ji H et al. (2013, May). A report of 918 cases of circumcision with the Shang Ring: comparison between children and adults. Urology. 81(5): 1058-1063. Epub 2013 Mar 7. https://doi.org/10.1016/j.urology.2012.11.046; PMid:23465168

35. Yegane RA, Kheirollahi AR, Salehi NA, Bashashati M, Khoshdel JA, Ahmadi M. (2006). Late complications of circumcision in Iran. Pediatr Surg Int. 22: 442-445. https://doi.org/10.1007/s00383-006-1672-1; PMid:16649052

36. Zhang Q, Gao L, Liu D, Song G, Gao P, Zhang S et al. (2022, Dec 23). Comparative analysis on the outcomes in circumcising children using modified Chinese ShangRing and conventional surgical circumcision. Pediatr Surg Int. 39(1): 59. https://doi.org/10.1007/s00383-022-05343-4; PMid:36550318