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G106 Non-Therapeutic Circumcision in ‘High-Risk’ Children in a Children’s Hospital: Consent and Safety
  1. S Collinson1,
  2. J Brierley2
  1. 1Medical School, St Georges, London, UK
  2. 2Clinical Ethics Service, Great Ormond St Hospital, London, UK

Abstract

Aims Non-therapeutic circumcision (NTC) is controversial. Religious freedoms and suggested health benefits are balanced against a non-medically indicated surgery in children who cannot consent. Many hospitals don’t offer NTC, which is therefore done in the community – however certain underlying health conditions mean NTC with access to specialist services occurs.

Whilst neither condoning, nor criticising this, we wanted to ascertain NTC safety in ‘high-risk’ children, and to assess the quality of consent given by both parents as the BMA and BAPS suggest.

Methods Retrospective 2-year case-note review (2009–10) of circumcisions in a tertiary children’s hospital. Hospital admissions/surgical databases searched and NTC medical notes interrogated for consent forms, notes entries and other indicators of explanations to parents/family together with medical and surgical complications and outcomes. Whilst demographic information, ethnic origin, religion and underlying medical condition recorded, only the last is reported here.

Results 199 circumcisions (all male) were performed. Exclusions: 181 part of larger procedure/medically indicated = 18 NTC. Age 4.5 +/- 4.0. Underlying conditions: Bleeding disorder 6, cardiac defect 5, respiratory problem 3, renal failure 1, leukaemia 1, vitamin B12 deficiency 1, megalocornea 1

Consent record: Risk documented: Generic bleeding (100%), infection (96%), <5% all others (serious haemorrhage, sepsis, fistula, penile loss, GA risks). No mention of risks re underlying disease. No record of both parents consenting.

Outcomes of procedure: Readmissions 0, Length of stay: mean 1.8 days (1–4), 60% day case. 4 stayed 3–4 days (3 bleeding disorders 2 transexamic acid cover)

Complications 1) procedure: None 16, facial scratch 1, tooth lost 1; 2) post procedure: None 11, ooze/mild wound bleeding 3, moderate bleeding 1, bradycardic during recovery 2, mild swelling/moderate pain 1, fever/cough 1. All resolved without long-term effects.

Conclusion Whilst NTC in ‘high-risk’ children is relatively safe in our specialist centre, with only minor self-limiting complications, consent documentation is poor. Although verbal explanation might have been better than that recorded inadequate recording of those risks discussed and the absence of documented consent from both parents is medico-legally problematic.

Standardization of NTC risks explained to families and consent records from both parents must be ensured.

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