https://doi.org/10.4081/aiua.2025.13999
Comparison of novel dorsal buttonhole slit versus conventional dorsal slit circumcision: efficacy, safety, and parents’ satisfaction
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 30 September 2025
Introduction and objective: Circumcision is the most frequently performed surgical procedure worldwide. The World Health Organization recommends that circumcisions be performed by dorsal slit incision. This study introduces the dorsal buttonhole slit, a novel modification of the conventional dorsal slit technique, and aims to evaluate its clinical outcomes and safety in a pediatric cohort.
Materials and methods: This retrospective descriptive study was conducted on 107 pediatric patients aged 1-10 years who underwent circumcision for religious reasons or phimosis between January 2022 and December 2023. Patients were divided into two groups based on the surgical technique used: dorsal buttonhole slit (n=56) vs conventional dorsal slit (n=51). The assessment parameters included intra-operative hemorrhage, operating time, healing time, postoperative complications, and parental satisfaction.
Results: The mean operative time was significantly shorter in the dorsal buttonhole slit group compared to the conventional group (293.79 vs 320.67 seconds, respectively; p=0.028). There was no significant difference in wound healing time between the two groups. No postoperative complications, such as hemorrhage or need for revision, were observed in any patient during the 1-month follow-up period. All parents reported satisfaction with the functional and cosmetic results.
Conclusions: The dorsal buttonhole slit technique was associated with a shorter operative time and excellent safety outcomes. While these results are promising, prospective randomized trials are required to definitively confirm the efficacy and safety of this method. The technique shows potential as a reproducible and reliable alternative for pediatric circumcision.
Downloads
1. Shenoy SP, Marla PK, Sharma P, et al. Frenulum sparing circumcision: step-by-step approach of a novel technique. J Clin Diagn Res JCDR 2015; 9:PC01-3.
2. Jiang Z-L, Sun C-W, Sun J, et al. Subcutaneous tissue-sparing dorsal slit with new marking technique. Medicine (Baltimore) 2019;98:e15322.
3. Lei J-H, Liu L-R, Wei Q, et al. Circumcision with “no-flip Shang Ring” and “Dorsal Slit” methods for adult males: a single-centered, prospective, clinical study. Asian J Androl 2016; 18:798-802.
4. Lukong CS. Dorsal slit-sleeve technique for male circumcision. J Surg Tech Case Rep 2012;4:94-7.
5. Krill AJ, Palmer LS, Palmer JS. Complications of circumcision. Sci World J 2011;11:2458-2468.
6. Talini C, Antunes LA, Carvalho BCN de, et al. Circumcision: postoperative complications that required reoperation. Einstein São Paulo 2018; 16:eAO4241.
7. Weiss HA, Larke N, Halperin D, et al. Complications of circumcision in male neonates, infants and children: a systematic review. BMC Urol 2010; 10:2.
8. Roth JD, Keenan AC, Carroll AE, et al. Readmission characteristics of elective pediatric circumcisions using large-scale administrative data. J Pediatr Urol 2016; 12:27.e1-6.
9. Warees WM, Anand S, Leslie SW, Rodriguez AM. Circumcision. Treasure Island, StatPearls Publishing; 2025.
10. Abdulwahab-Ahmed A, Mungadi I. Techniques of male circumcision. J Surg Tech Case Rep 2013; 5:1.
11. Azizoglu M, Risteski T, Klyuev S. Alisklamp versus conventional dorsal slit circumcision: a multicentric randomized controlled trial. J Clin Med 2024; 13:4568.
12. Abdullah L, Mohammad A, Anyanwu L, et al. Outcome of male circumcision: A comparison between plastibell and dorsal slit methods. Niger J Basic Clin Sci 2018; 15:5.
13. Atikeler MK, Geçit I, Yüzge. V, et al. Complications of circumcision performed within and outside the hospital. Int Urol Nephrol 2005; 37:97-9.
14. Ozkan A, Ozorak A, Oruc M. Retrospective investigation complications in nineteen hundred cases of circumcision. Konuralp Med J 2012; 4:8-12.
15. Brisson PA, Patel HI, Feins NR. Revision of circumcision in children: Report of 56 cases. J Pediatr Surg 2002; 37:1343-1346.
16. Niku SD, Stock JA, Kaplan GW. Neonatal circumcision. Urol Clin North Am 1995; 22:57-65.
How to Cite
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.