بررسي روش Mogen clamp در ختنه كودكان

بررسي روش Mogen clamp در ختنه كودكان

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Use of the Mogen clamp for neonatal circumcision.

Reynolds RD.

University of Cincinnati College of Medicine, Ohio, USA.

Most newborn circumcisions performed in the United States are done with either a Gomco clamp or a Plastibell device. The Mogen clamp, devised by a jewish mohel, provides a quick and simple surgical alternative. The foreskin is freed from the glans by blunt dissection, but no dorsal slit is made. A dorsal hemostat is placed, and traction is applied to bring the foreskin forward. Placement of the Mogen clamp follows the angle of the corona to avoid removing excess skin ventrally and to obtain a superior cosmetic result. The clamp crushes the foreskin along a line that is 1 mm wide, and the foreskin is excised distal to the clamp. After removal of the clamp, the glans is liberated by pulling the crush line apart. The procedure usually takes three to four minutes and is virtually bloodless.

PMID: 8677833 [PubMed - indexed for MEDLINE]

 

Mogen clamp.

1: Clin Pediatr (Phila). 1984 Dec;23(12):679-82.Links

Circumcision using the Mogen clamp.

Kaweblum YA, Press S, Kogan L, Levine M, Kaweblum M.

The purpose of this study was to analyze the results of 313 circumcisions using the Mogen clamp. This procedure was done between 1 day and 2 years of age in all but four patients. The complication rate was low (1.6%). Two patients had local infection, one mild hemorrhage, one concealed penis, and one postcircumcision phimosis. Circumcision using the Mogen clamp is a simple, quick, and safe procedure.

PMID: 6499347 [PubMed - indexed for MEDLINE]

Instruments & Techniques

The choice of which technique to use to perform a safe circumcision is a professional decision for all Mohalim. There is no absolute best. Each Mohel has their personal favorite which is usually based on what they were taught during their medical training. The technique used is determined by the specific instrument be it the Mogen Clamp or Shield, Gomco, Plasti-Bell or other.

I personally use the Mogen Clamp (click here for example). I have, in the past, tried the other methods but for the duration of my career I have exclusively used the Mogen .

I use this instrument for several reasons. First, it is a traditional instrument, its fundamental design is based on the original circumcision instrument used for hundreds of years.

Second, a circumcision performed using a Mogen Clamp is more rapid than other methods. Procedure time with this instrument is approximately 30 - 60 seconds (one minute) and requires only one cut. A circumcision that takes 60 seconds seems to affect the baby less than a longer procedure. As a result of the rapidity of this procedure, I believe there is significantly less trauma to the baby.

The Gomco or Plasti-Bell instruments generally require a minimum of 5 minutes to perform a circumcision. Sometimes the procedure takes even longer. These instruments are more anatomically dependent with the need to use different sized bells for different babies. Additionally, they require the baby to be cut twice to accomplish the circumcision. Thus, I believe there is more trauma to the baby with their use.

Safety is of paramount importance with any circumcision. All instruments are equally safe in experienced hands. The difference arises with less experienced practioners. In that case a Gomco or Plasti-Bell is a bit more forgiving and allows a slightly wider margin of error for safety. I have never experienced an untoward problem with my use of a Mogen in 18 years of practice.

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Pain during Mogen or PlastiBell circumcision.

Taeusch HW, Martinez AM, Partridge JC, Sniderman S, Armstrong-Wells J, Fuentes-Afflick E.

San Francisco General Hospital and Department of Pediatrics, University of California, San Francisco, CA 94114, USA.

Routine neonatal circumcision can be a painful procedure. Although analgesia for circumcision has been studied extensively, there are few studies comparing which surgical technique may be associated with the least pain and discomfort when carried out by pediatric trainees.OBJECTIVE: We studied two commonly used techniques for circumcision to determine which was associated with less pain and discomfort. STUDY DESIGN: In a randomized, prospective, but not blinded study, newborns were circumcised either by Mogen clamp or by PlastiBell. All received dorsal nerve blocks with lidocaine. Fifty-nine well, term, newborn infants at San Francisco General Hospital were studied from 1997 to 1998. Circumcisions were carried out mostly by interns and residents in family practice and pediatrics. Pain was assessed by measuring duration of the procedure and by a simple behavioral score done sequentially. RESULTS: Dorsal nerve blocks were judged to be fully effective in over 70% of cases. Neither Mogen nor PlastiBell was associated with greater pain per 3-minute time period, but the PlastiBell technique on average took nearly twice as long as the Mogen procedure (20 vs 12 minutes). We judged that 60% of the infants had pain or discomfort associated with the procedure that was excessive. Residents and interns universally preferred the Mogen technique over the PlastiBell because of the former's simplicity. CONCLUSION: During the procedure, Mogen circumcision is associated with less pain and discomfort, takes less time, and is preferred by trainees when compared with the PlastiBell