Hollister Plastibell
Hollister makes the Plastibell, which is a plastic bell with a groove close to the edge. It is a disposable plastic device. The bell is inserted into the preputial cavity (over the glans, and under the foreskin) and the foreskin (prepuce) is tied around it with a tight string. Blood flow to the prepuce is ceased, and the prepuce forward of the string is cut off. After several days, the prepuce caught under the string necrotizes and falls off, providing a bloodless circumcision, with no open wound to become irritated or infected.
Because of the danger of the plastic ring being pulled back behind the glans, only the foreskin that naturally covers the glans can be safely removed using the Plastibell. Hence it usually results in a looser, although a visually appealing, circumcision not unlike the newly developed Tara KLamp.
The Plastibell is primarily used on infants in the United States, although youth, teen
and adult models are sometimes used in Europe. The Plastibell is
used in nearly 60% of all routine infant circumcisions in the US with 39% being done by
the Gomco Clamp in the United States.
The makers of the Gomco (Allied Healthcare Products, Inc., St. Louis MO) at one time produced a disposable plastic clamp as well
we believe may have been called the "Circlamp". It is very similar to the Tibone clamp, only of a disposable nature. It is no longer in production. For many years after, the Hollister Plastibell was the only disposable circumcision device in use until the recent advent of the Tara KLamp,
Sunathrone, and other disposable devices.
Both the
Gomco Clamp and the Plastibell, if used in accordance with the maker's recommendations,
crush the foreskin. The biggest difference is that the Plastibell works entirely by this
method whereas the Gomco crushes only until the unwanted skin is cut away to perform the
actual circumcision. In theory either should produce equally cosmetic results.
A 9 year old boy is shown here with a long, tight foreskin, before the Plastibell is applied. Below the simple procedure is completed and the Plastibell is in place and will remain on the boy's penis for approximately 7 days before falling off (usually in the bath).
Because the Plastibell remains on the penis for 5 - 10 days 
whilst it does its job, and is pulled tight against the glans by the foreskin trying to retract back to its unstretched position, Hollister recommend that the foreskin should not be pulled too far forward before being trapped by the thread around the Plastibell's groove. This results in a necessarily looser circumcision than can be achieved with the Gomco clamp. Furthermore, the position of the scar line behind the glans is determined only by the distance from the back of the glans to the groove in the 'bell. For a given glans circumference (and hence Plastibell size) the longer the boy's glans the further back the resulting scar line will be and the looser the circumcision will be.
If the Plastibell is fixed too tightly then the front of it can dig into the glans and cause problems, including obstruction of the urethra, because it is there for a week or so. The photo at left shows the Plastibell properly applied immediately after the procedure and the final result was most satisfactory with no loose foreskin covering the boy's glans when flaccid.
The step of clamping the foreskin to the handle of the 'bell seems to me to be one which doctors would have taken automatically if working alone - otherwise there is no way of ensuring that the foreskin stays in place over the bell whilst tying the knots to perform the circumcision proper. If there is an assistant doctor (or nurse) present then they can hold the end of the foreskin in forceps whilst thesurgeon ties the knot. This step of keeping the foreskin pulled forward is essential if the Plastibell is to remove an adequate amount of foreskin.
However, the instructions for the Plastibell explicitly state that the skin should not
be pulled too tight before being tied off. This is because if pulled very tight there will
be considerable tension backwards after the bell has been tied in place. The end of the
bell will be pulled into the glans and may easily compress the urethra to the extent of
making urination very painful, if not impossible. A wise surgeon passes a probe down the
urethra after fixing the bell so as to prove that it is not obstructed. Only then does he
finally cut the thread to length.
The Plastibell is an ideal tool for use by relatively unskilled medics such as
midwives, junior doctors, etc since the only real skill required is the ability to tie a
surgical knot that will not come undone over a period of 10 days or so. It makes a very
neat job with a smooth scar line and ensures that the frenulum cannot be cut. There is
also virtually no blood loss and, in more skilled hands, it can even be used on
haemophiliac boys (whereas no other circumcision method can).
The largest Plastibell generally commercially available in the United States and Great
Britain is designed to fit the 'average' 11-12 year old boy. (Adult size Plastibells
are available in Europe.) Well developed boys of this age may well have too large a
glans to use the Plastibell, whereas very late developers may be able to be circumcised
with it to 14 or so years old. It is very important that the correct size bell is used to
avoid damage to the glans, etc.
The Plastibell can be applied quickly and easily under either local or general
anaesthesia. If general is used then after the bell is fixed, a local shot should also be
given to ensure at least 2 hours continued anaesthesia after the general has worn off. The
action of the thread in the groove of the bell is such that within this time not only has
the blood supply been cut off from the foreskin, but the nerve endings at, and forward of,
the thread are rendered ineffective. All the boy will feel is a slight pressure from the
bell on the glans.
Because no stitches are used with a Plastibell there is no need for dressings,
antibiotics, etc which makes things very much simpler, especially with young children who
cannot easily co-operate. Where stitches are used they will take from 2 weeks onwards to
completely dissolve and the child must be stopped from pulling at them in the meantime.
Pain from the circumcision site is, to a great extent, related to the degree of desire for
the operation. A boy who actively requests and wants it will not notice the pain as much
as one who actively opposed the operation, or who simply wasn't consulted.
Pediatr
Surg Int. 2006 Oct 6; [Epubahead of print] Related Articles,
A unique service in UK delivering
Plastibell((R)) circumcision: review of 9-year results.
Palit V, Menebhi DK, Taylor I, Young M,
Elmasry Y, Shah T.
Yorkshire Deanery, 11 Mildred Avenue,
Royton, Oldham, Lancashire, OL2 6AD, UK,
victorpalit@yahoo.co.uk.
Muslim infants undergo circumcision for
religious reasons and Bradford has a high Muslim population. The National Health
Service in UK does not provide religious circumcision, so in1996 a
nurse-delivered circumcision service led by consultant urologists was set up at
a no-profit and cost-only basis. Plastibell circumcision was offered to all
infants between 6 and14 weeks old and performed under local anaesthesia.
Information leaflets and videotapes about the procedure were available to
parents prior to the procedure. A three monthly audit of the service was
undertaken. Between July 1996 and June 2005 (9years) 1,129 circumcisions were
performed. The common complications were problems with the ring (3.6%) and
bleeding(3%). Overall, there was 96% satisfaction rate among the service users.
The Plastibell technique for circumcision is a simple method and can be safely
performed by trained nurses with acceptable complication rates.
PMID: 17024296 [PubMed - as supplied by
publisher]
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