Complications of circumcision in Israel: a one year multicenter survey.

BACKGROUND In Israel, virtually all children undergo circumcision in the neonatal period. Traditionally, it is commonly performed by a "Mohel" (ritual circumciser) but lately there is an increasing tendency among the educated secular population to prefer a medical procedure performed by a physician and with local anesthetic injection. OBJECTIVES To evaluate the outcome of this procedure and to compare the complication rate following circumcisions performed by ritual circumcisers and by physicians. METHODS In 2001, of the 19,478 males born in four major medical centers in Israel 66 had circumcision-related complications. All the children were circumcised in non-medical settings within the community. The patients were medically evaluated either urgently due to immediate complications or electively in outpatient clinics later on. Upon the initial assessment a detailed questionnaire was filled to obtain data regarding the procedure, the performer, and the subsequent complications. RESULTS All the circumcisions were performed during the early neonatal period, usually on day 8 of life (according to Jewish law). in 55 cases (83%) it was part of a ritual ceremony conducted by a ritual circumciser (Mohel), while in 11 babies (17%) physicians were involved. Acute bleeding after circumcision was encountered in 16 cases (24%), which required suturing in 8. In addition, we found two cases of wound infection and one case of partial amputation of glans penis in which the circumcision was performed by a ritual circumciser. Among the late complications, the most common was excess of skin in 38 cases (57%); 5 children (7.5%) had penile torsion and 4 children (6%) had shortages of skin, phimosis and inclusion cyst. The overall estimated complication rate of circumcision was 0.34%. CONCLUSIONS Complications of circumcision are rare in Israel and in most cases are mild and correctable. There appears to be no significant difference in the type of complications between medical and ritual circumcisions.