1. Infants randomized to Mogen circumcision had a smaller increase in salivary cortisol levels.
2. Mogen circumcisions were shorter in duration compared to Gomco procedures.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Circumcision, or removal of the prepuce (foreskin) of the penis, is a procedure commonly performed by both obstetricians and pediatricians. The United States has one of the highest rates of circumcision, with a prevalence of approximately 80%. The majority of circumcisions are performed in newborns. Circumcision has been associated with benefits such as lower rates of urinary tract infection, sexually transmitted infection, and penile cancer. While routine circumcision is not recommended, both the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists have published opinions that the benefits outweigh the risks. Although circumcision is common, there is minimal literature on optimal teaching methods, techniques and complications. To date, one randomized trial compared Mogen and Gomco circumcision, two of the most commonly used techniques, but this occurred prior to the mandatory use of anesthesia during circumcision. In the present work, authors compared these two methods following a standardized curriculum for resident physicians and found that Mogen circumcision was shorter in duration and associated with decreased postoperative pain.
Strengths of the study include randomization and use of multiple measures of neonatal pain. Limitations include diurnal variations in cortisol levels and lack of blinding of the nurses performing pain assessments, which may have introduced confounding and experimenter bias. Findings suggest Mogen circumcision may be superior to Gomco but confirmatory studies including follow-up assessment of pain, healing and cosmesis are merited.
In-Depth [randomized controlled trial]: This study compared two circumcision techniques in healthy newborn male infants randomized to receive Gomco (n = 121) or Mogen (n = 130) circumcisions. The primary outcome of interest was neonatal pain, as assessed by salivary cortisol levels and CRIES, a validated pain assessment tool, scores. Secondary outcomes included procedure time, bleeding, parental satisfaction and pediatrician assessment.
Infants undergoing Mogen circumcision had a smaller increase in salivary cortisol levels (p = 0.049), shorter procedures times (p < 0.001) but no difference in CRIES score compared to infants undergoing Gomco circumcision. Compared to those undergoing Mogen, infants undergoing Gomco circumcision experienced increases in postoperative heart rate (p = 0.015) and mean arterial blood pressure (p = 0.012).
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