# Clinical Outcomes of Plastibell Circumcision in Infants Below Three Months of Age: A Retrospective Study From a Tertiary Care Center

## TL;DR

This study examines the safety of Plastibell circumcision in infants under three months and finds that ring size is the main factor affecting complications.

## Contribution

The study identifies ring size as the only significant predictor of complications in Plastibell circumcision among neonates.

## Key findings

- Complications occurred in 3.1% of 552 neonates undergoing Plastibell circumcision.
- Ring size 1.3 was the only independent predictor of complications (OR 2.10; p = 0.048).
- Age, weight, surgeon level, and diathermy use were not significant predictors of complications.

## Abstract

Introduction: Plastibell circumcision is widely practiced in neonates because of its simplicity and low complication rate. Understanding factors influencing safety, especially ring size and operator experience, is essential for reducing preventable complications.

Objective: The objective of the study is to determine the rate and predictors of complications following neonatal Plastibell circumcision in a tertiary military hospital.

Methods: A retrospective cohort study of all male neonates < 90 days was done, who underwent Plastibell circumcision between June 2024 and May 2025 at Prince Sultan Military Medical City. Variables included age, weight, ring size, surgeon level, diathermy use, and postoperative outcomes upon presentation to the hospital. Statistical analysis included chi-squared tests and multivariable logistic regression.

Results: Among 552 neonates, complications among patients presenting to the hospital occurred in 17 (3.1%), which were bleeding in 15 (2.7%), infection in one (0.2%), and ring migration in one (0.2%). Ring size 1.3 was the only independent predictor of complications (odds ratio (OR) 2.10; p = 0.048). Age, weight, surgeon level, and diathermy use were not significant predictors.

Conclusion: Neonatal Plastibell circumcision is safe with a low complication rate. Ring-size selection remains the main modifiable factor, highlighting the importance of objective sizing protocols and enhanced surgical training.