J. A. Sujka1, R. Sola1, A. Lay1, S. St. Peter1 1Children’s Mercy Hospital- University Of Missouri Kansas City,Kansas City, MO, USA
Introduction:
Children with single ventricle physiology (SVP), especially hypoplastic left heart syndrome, have been shown to have a high morbidity and mortality after major non-cardiac surgical procedures. Elective circumcision, a cosmetic procedure, is one of the most common operations for infants and children with a very low morbidity with <1% of patients requiring readmission or reoperation. The purpose of our study was to review our institutional experience with SVP children undergoing circumcisions to determine the peri-operative course and outcomes.
Methods:
With IRB approval, we performed a retrospective review of children with SVP who underwent an elective circumcision from 2000 to 2017. Children with SVP include hypoplastic left heart syndrome, double outlet right ventricle, and tricuspid atresia. Children with non-single ventricle physiology congenital heart disease and those children undergoing circumcision in combination with another case were excluded from the study. Patient’s demographics, surgical characteristics and outcomes were analyzed. All means reported ± standard deviation.
Results:
There were 15 males who underwent elective circumcision from 2000 to 2017. The mean gestational age at birth was 37.7 ± 2.65 weeks. Their mean age at the time of their surgery was 1.39 ± 0.82 years old. Their mean weight was 9.7 ± 1.6 kg. Fourteen were Caucasian and one was African American. Eleven of fifteen (73%) children were diagnosed with hypoplastic left heart syndrome, all had undergone their first stage procedure with 10 of 15 (66%) undergoing a Norwood Reconstruction as their first stage operation.
All children underwent a circumcision due to uncomplicated phimosis. Thirteen (87%) of the children underwent a freehand circumcision. Eighty four percent underwent their circumcision after their 2nd stage cardiac operation with only two patients having their circumcision after their 3rdstage cardiac surgery.
The mean operative time was 20 ± 7 minutes and there was a mean total length of stay of 247 ± 98 minutes. None of the children were admitted after their circumcision. There were no intraoperative complications. Post-operative complications included two (16.7%) hematomas with one requiring surgical intervention. Both complications occurred in patients undergoing a freehand circumcision. There were no deaths within the first 30 days after surgery. There were no unplanned readmissions in one year after surgery.
Conclusion:
Children with single ventricle physiology who undergo elective circumcision may have higher risk of complications, especially bleeding, compared to the general population. Further investigations with more patients to better define the risk and allow for definitive recommendations are needed.