Stapler Circumcision - Surgery, Procedure and Recovery Time

It is a modern surgical technique to remove the foreskin (skin that covers and protects the penis’ tip) using a stapler. A stapler is an advanced disposable circumcision device which is used to cut the skin edges and seal them.

A stapler circumcision may be performed for multiple reasons, which will be discussed in later sections. Though originated for religious and cultural reasons, stapler circumcision may be performed for medical reasons as well.

Anatomy of the Penis

The penis is a male reproductive organ present externally. It consists of muscles and tissues but no bones. Apart from the reproductive role it plays several other roles such as helping a man urinate, etc.

The penis has primarily three parts, namely:

• Root: The part that is present inside the body and consists of three tissues that help with erection.

• Shaft: It may be referred to as the body and contains three cylindrical erectile tissues.

• Glans: A bulb-like appearing end-part of the penis. It has a urethral opening that allows the man to expel urine or semen.

It is generally performed in older boys and adult men. Its primary benefit is reducing the risk of certain penile conditions and sexually transmitted infections.

Conditions Treated with Stapler Circumcision

Though not necessary, circumcision may be performed for varying purposes. Some medical conditions treated by circumcision stapler include:

1. Phimosis: Tight foreskin that cannot be pulled back. One of the most common indications for surgical circumcision is pathological phimosis.

2. Paraphimosis: Somewhat the opposite of phimosis, in paraphimosis, the foreskin can be retracted but cannot be moved back to its original position. This may cause the tip of the penis to become tender and swollen.

3. Balanoposthitis: A condition which causes irritation, itching, and swelling of the foreskin and glans.

4. Balanitis: An inflammatory condition with redness, soreness, and swelling of the glans of the penis.

5. Balanitis Xerotica Obliterans: A chronic condition that causes phimosis and in some cases, also affects the glans causing inflammation.

6. Preventive Treatment: A stapler circumcision may also be performed to prevent multiple complications. This may include:

• Penile Cancer

• Sexually Transmitted Infections

• Urinary Tract Infections

Note: The above-mentioned factors may help identify your eligibility for a stapler discussion. Meanwhile, it is crucial to discuss the indications with a doctor. Consider visiting a urologist if you notice something unusual.

It is carried out on an outpatient basis. The surgery usually takes about 15 to 20 minutes. The procedure is generally performed under local or general anaesthesia by a specialized team of anaesthetists, surgeon or urologist.

In the case of newborn baby boys, the procedure is performed by a paediatrician or obstetrician. An instrument called circumcision anastomotic stapler, a disposable device is used while performing the procedure.

It consists of two parts, an inner and an outer bell which protects the glans and a circular blade to cut the foreskin and a staple to close the wound.

The below-mentioned steps are involved in stapler circumcision: 

In newborns

• It is usually done within 10 days after birth.

• The newborn boy will be laid down on his back with his arms and legs firmly held.

• The penis and the surrounding area will then be cleaned, and anaesthesia will be injected.

• A plastic ring or special clamp will be attached, and the foreskin will then be removed.

• After that, the penis will be covered with an antibiotic cream.

In older boys and adults

• The surgeon will first measure the size of the penis just below the glans. 

• Then the anaesthetist will administer general anaesthesia to the patient.

• Afterwards, the area will be cleaned with antiseptic solutions like povidone or iodine.

• An incision is then made at the foreskin to facilitate the insertion of the inner bell.

• Once the inner bell is inserted, the surgeon will confirm its correct position.

• It is fixed to the foreskin by using a surgical tie.

• The inner bell is then screwed into the outer bell, and its correct positions are confirmed.

• After that, the safety pin is removed, and the stapler will be fired and held for 3 minutes to ensure a clean cut of the foreskin and compression of blood vessels.

• The inner bell is partially released to check the transaction of the foreskin and haemostasis.

• The wound is cleaned again with an antiseptic.

• The penis is bandaged with special compression bandages.

The patient may expect the following before or on the day of the surgery.

Before Stapler Circumcision Surgery

A few days before surgery, the surgeon will schedule an appointment with the patient for the following:

1. A complete physical check-up also includes details about the patient's medical history.

2. The surgeon will explain the circumcision procedure and the benefits and risks of performing the surgery.

3. If the patient uses blood-thinning medications (e.g., aspirin), the urologist will ask the patient to stop taking those a few days before surgery.

4. The doctor will decide the type of anaesthesia for the patient based on the health condition of the patient.

5. The patient will be asked about all the medications, supplements or herbal products that he takes.

6. The patient should not consume anything at least six hours before the surgery.

7. If circumcision is scheduled for a newborn boy, the parents should feed the baby with formula milk for six hours or breast milk four hours before surgery.

8. If a child older than one year is scheduled for circumcision, do not feed him with solid foods (including chewing gum and candy) or liquids (e.g., milk, fruit juice, and formula) after midnight.

On the day of Stapler Circumcision Surgery

Once the patient (adult male or newborn boy) arrives at the hospital on the day of surgery, the healthcare staff will direct the next procedures:

1. Consent will be asked from the patient, and a ZSR circumcision anastomotic stapler of a suitable size will be selected for you after measurements.

2. The patient will be requested to remove any jewellery, contact lenses, or objects from the body.

3. The patient will also be asked to remove clothes and change them into a hospital gown.

4. The healthcare staff will provide the patient with an identification bracelet.

5. The healthcare staff will also record the patient's blood pressure, pulse rate, and blood pressure and then take the patient to the operating room.

A patient who has undergone circumcision stapler surgery can expect the following after the surgery:

The Recovery Process in the Hospital

• Post-surgery, the patient will be shifted to the recovery room where the patient will be kept under observation.

• The patient will be kept in observation until the after-effect of anaesthesia wears off.

• The tip of the penis will be sore at first, and the penis can look red, swollen, or bruised.

• The patient may also see yellow fluid on the tip of the penis.

• The general surgeon will also prescribe some medications and painkillers to the patient.

• Once the patient's condition stabilizes, the urologist doctor will discharge the patient.

Recovery Process/Expectation after Hospital Discharge

• Instructions provided by the general doctor must follow at home.

• The patient will be advised to avoid putting pressure on the penis.

• Washing the penis after it heals is important. For newborns, the bandage should be changed just like the mother changes each diaper, and apply petroleum jelly to the tip of the penis to prevent it from sticking.
  
  Change diapers often, and make sure the diaper is loosely fastened.

• If the doctor had placed a plastic ring instead of a bandage, it would fall off on its own within a week. Once the penis heals, the patient can wash it with the help of soap and water during normal bathing.

• The adult men will be advised not to be involved in sexual intercourse for about 3 weeks.

• If the patient has a dressing, he should keep the dressing for 2 to 3 days post-surgery or as recommended by the surgeon.

• The patient should keep himself hydrated within the first 24 hours after surgery.

First Follow-up Appointment

• The general surgeon/doctor will inform the patient when will need to visit for the first follow-up.

• The patient will usually be asked for follow-up after a day, then at 1, 2, and 3 weeks, and 1 and 3 months after surgery.

• The doctor will examine the treated area to detect the recovery status.

• The doctor will also prescribe some medications or ointments for properly healing the wound.

• The patient will also be informed regarding future visits to examine if the implant is in place and functioning correctly.

Stapler circumcision is a safe procedure which not only helps in reducing the risk of penile diseases, but it can also improves hygiene. This procedure has several benefits including:

• Minimal injury to the tissue and lower blood loss (by volume)
• Shorter operation time
• Fewer post-op complications
• Faster recovery compared to conventional circumcision
• The procedure can be safely performed on children and adults
  
  

Like any other surgery, the stapler procedure circumcision also has some potential risks and complications, such as:

• Bleeding
• Oedema
• Pain
• Wound infection
• Residual staples: The staples are held together with the help of a silicone ring, which usually falls within 1 to 2 weeks. Some staples may not fall, and a physician's intervention will be required.
• Wound dehiscence: If the wound edges fail to close, the doctor may decide to close the wound with the help of sutures, although stapler circumcision is a sutureless technique.

When is consultation with the doctor needed?

The patient may have to consult the urologist doctor earlier if he experiences the following:

• Foul-smelling drainage from the tip of the penis.
• If normal urination doesn't start within 12 hours.
• The plastic ring doesn't drop off even after 2 weeks.
• Persistent bleeding.

For non-medical reasons, delayed circumcision does not have any negative consequences. However, in case of medical reasons, delayed circumcision can lead to the progression of the underlying conditions, like:

1. Untreated balanitis can lead to chronic (extended) inflammation (redness, soreness, and pain).
2. Similarly, long-standing phimosis can lead to permanent scarring, causing the constriction of the foreskin. It may also lead to dyspareunia (painful intercourse) in patients with diabetes.
3. Stapler circumcision may increase sensitivity of the penis and the patient may feel more pain, irritation, etc. than usual. However, this is rare. 
   
   

The stapler circumcision price ranges from ₹30,000 to ₹80,000. The cost varies based on the following factors:

• Age of the patient
• Condition of the foreskin (Phimosis, Paraphimosis, Balanitis).
• Technique and equipment used
• Other medical conditions that the patient may have.
• The type of hospital facility availed - individual room or shared.