Circumcision devices versus standard surgical techniques in adolescent and adult male circumcisions: A Cochrane review.

Abstract

OBJECTIVES\nTo assess the effects of device-based circumcisions compared with standard surgical techniques in adolescent and adult males (10 years old and above).\n\n\nMETHODS\nWe performed a comprehensive search with no restrictions to the language of publication or publication status. We included randomised controlled trials (RCTs) of device-based circumcisions compared to standard surgical dissection-based circumcision conducted by health professionals in a medical setting. We reported study results as risk ratios (RR) or mean differences (MD) using 95% confidence intervals (CI) and a random-effects model. We used the GRADE approach to evaluate the overall certainty of the evidence for each outcome.\n\n\nRESULTS\nEighteen trials met the inclusion criteria. These trials did not report severe adverse events (11 trials, 3472 participants). There may be a slight increase in moderate adverse events for devices compared to surgical techniques (RR 1.31, 95% CI 0.55 to 3.10; I2 = 68%; 10 trials, 3370 participants; low-certainty evidence); this corresponds to 8 more (ranging from 15 fewer to 84 more) moderate adverse events per 1000 participants. We are uncertain about the difference in mild adverse events between groups when devices are used compared to surgical techniques (RR 1.09, 95% CI 0.44 to 2.72; I2 = 91%; 10 trials, 3370 participants; very low-certainty evidence).\n\n\nCONCLUSIONS\nWe found no serious adverse events using a circumcision device compared to surgical techniques. Still, they may slightly increase moderate adverse effects, and it is unclear whether there is a difference in mild adverse effects. High-quality trials evaluating this intervention are needed to provide further certainty regarding the rates of adverse events. Clinicians, patients and policymakers can use these results combined with their contextual factors to inform the best approach that suits their healthcare settings.