PEDIATRIC CIRCUMCISION (KHATNA): PRACTICE PATTERNS, TECHNIQUES, AND EARLY COMPLICATIONS

Abstract

Background: Circumcision (Khatna) is among the most commonly performed pediatric procedures. While benefits are recognized, complications occur—especially with inexperienced providers, non-sterile conditions, or higher-risk ages. We evaluated outcomes and practice factors in a pediatric surgical unit and interpreted them against contemporary evidence.

Methods: Cross-sectional study conducted at Liaquat University of Medical & Health Sciences Jamshoro, from October 2022 to October 2025. Boys aged 1 month to 14 years undergoing circumcision were enrolled by convenience sampling (n=145). Exclusions: age <1 month or >14 years; congenital external genital anomalies. Data collected included age, indication, method, provider, anesthesia, setting, and outcomes at 7–10 and 30 days. Complications were graded as minor (requiring conservative care), moderate (requiring outpatient procedural intervention), or severe (requiring admission, re-operation, or transfusion). Descriptive statistics with 95% confidence intervals (CIs) were used.

Results: Cultural/religious indications predominated (82.8%). Techniques: Plastibell 58.6%, Mogen clamp 19.3%, sleeve/dissection 16.6%, freehand 5.5%. Local anesthesia 75.9%. Overall complications 7.6% (11/145; 95% CI 3.9–13.1): minor 6.2%, moderate 0.7%, severe 0.7% (95% CI 0.02–3.8). By age: 11.5% (1–11 months), 7.3% (12–59 months), 3.1% (5–9 years), 5.0% (10–14 years). By method: Plastibell 8.2%, Mogen clamp 7.1%, sleeve 4.2%, freehand 12.5%. Common events: minor bleeding (2.8%), localized infection (2.1%), and Plastibell device issues (1.4%). One child required suturing; one required re-operation. No sequelae were documented at 30 days.

Conclusions: In a supervised, sterile environment, pediatric circumcision showed complication rates within international ranges for infant/child circumcision by medical providers. Risk reduction depends on consistent training, correct device sizing and glans protection, awareness of the 4–12-week “mini-puberty” bleeding risk, and standardized grading with reliable follow-up.