Determinants of the time of ring fall-off in plastibell circumcision: a systematic review

Background: Circumcision, a common surgical operation involving theremoval of the foreskin for religious, cultural, and medical reasons, is oneof the oldest surgical procedures. Delay in plastibell ring fall-off causesunacceptable sequelae such as penile necrosis, amputation, anxiety to thecarers. Several studies have documented the time of fall of plastibell ring;however, there is a dearth of systematic review on the factors that influencethe time of ring fall-off. Aim: In addition to determining the complication of plastibell circumcision,this review aimed to analyse the factors determining the time of ringfall off and how they correlate to the timing of fall off. Methodology: Data was collected from PubMed, EMBASE, and Scopusdatabases using the Preferred Reporting Items for Systematic Reviewsand Meta-Analyses guidelines. Results: The younger infants have an earlier average fall time with 7 daysand 9 days for 3 months and 8 months old infants respectively. Use of asitz bath ensures an average fall-off time of 7 days compared to 9 days ifthe sitz bath was not used. Polypropylene has a shorter fall-off time thancotton and a smaller plastibell thread size causes earlier fall-off. Ringretention and bleeding were the commonest complications with 25.8 and17.1% occurrence respectively. Recommendations: There is need to design algorithms consisting of acombination of these factors affecting the time of plastibell ring fall-offin order ensure the earliest possible time of fall-off. Conclusion: Conclusively, the study showed that the plastibell ring fallsoff earlier for younger infants, with the use of sitz bath, and in case of asmaller plastibell thread.