Originally known by the name “Shenghuan”, this circumcision device first appeared at the Hong Kong International Fair of Technology in 2003. Since then it has frequently been confused with the Zhenxi Ring, which is remarkably similar in appearance but functions quite differently.

The Shangring works quite differently to other disposable devices. Correct sizing is essential and a wide range is available. Ring-block local anaesthesia is used. The inner ring, which has a soft silicone insert, is placed over the shaft skin, 1 cm behind the coronal sulcus. The foreskin is then reflexed back over it, with a dorsal slit if necessary to make this possible in cases of phimosis. The outer ring, which has a knife-edge, is then placed over the inner ring and locked with the built-in clamp.

The knife-edge shape of the outer ring crushes both the outer and inner foreskin into the soft insert embedded into the structure of the inner component. The manufacturers claim a fitting time of around five minutes. The foreskin, which now lies behind the ring, is trimmed off with scissors.

The clamp prevents bleeding; there is no need for sutures. It is worn for about seven days, during which time necrosis of the remaining frill will occur in a manner similar to all fit-and-wear clamps. At that time a special tool is used to release the outer ring, whcih is removed, and then the inner ring is pushed back towards the body, away from the scar-line, and is removed with special scissors. A hair-dryer can be used to dry off the scar, and a specially shaped band-aid is used to cover the cut line for any remaining healing time. There is nothing left to the operator's control but since the foreskin is totally removed the result will always be a complete ("tight") circumcision, as shown below.

A Kenyan circumcision carried out with the Shang Ring. From Barone et al, JAIDS 2011 57 e7-e12 (see below)

Recently, alternative operative techniques using the Shang Ring have been published. The 'no-flip' technique, where the foreskin is not reflexed backward over the ring, is the main variation, but the question of allowing the device to fall off naturally rather than removing it at 7 days was also addressed. There were no adverse consequences of the no-flip method, which simplified operation where phimosis was present. Allowing spontaneus detachment was attended by fewer adverse incidents than removing at 7 days, though many in the 'spontaneous' group actually requested detachment before it happened naturally (which could take up to 14 days). The reference is listed below.

The device is sterilised by gamma radiation (Cobalt-60 exposure) and has a shelf life of 3 years. It is strictly non-reusable.

Academic publications about the Shang Ring

Peng et al, 2008, Clinical application of a new device for minimally invasive circumcision Asian J Androl 2008; 10 : 447–454.

MA Barone, F Ndede, PS Li, P Masson, Q Awori, J Okech, P Cherutich, N Muraguri, P Perchal, R Lee, HH Kim, M Goldstein, 2011. The Shang Ring Device for Adult Male Circumcision: A Proof of Concept Study in Kenya. JAIDS Journal of Acquired Immune Deficiency Syndromes: 57 e7-e12

MA Barone, PS Li, RK Lee, D Ouma, M Oundo, M Barasa, J Oketch, P Otiende, N Nyangweso, M Maina, N Kiswi, B Chirchir, M Goldstein, QD Awori. 2018. Simplifying the ShangRing technique for circumcision in boys and men: use of the no-flip technique with randomization to removal at 7 days versus spontaneous detachment. Asian J Androl. 2018 Nov 30. doi: 10.4103/aja.aja_91_18. [Epub ahead of print] Abstract here.

Known use of the Shang Ring

   

This clamp is widely used in China and is also being adopted elsewhere. Extensive trials are being conducted in sub-Saharan Africa, this device being one of a number of contenders for use in campaigns of mass circumcision as part of the WHO/UNAIDS anti-HIV programme.
http://www.ncbi.nlm.nih.gov/pubmed/20369555
http://www.ncbi.nlm.nih.gov/pubmed/20626160

A London clinic offers Shang Ring circumcision as well as traditional cutting methods:
The Integral Medical Centre, London