Figure 4a.
Plastibell in place, with the string
tied around the foreskin.

Plastibell Device

The Plastibell device is designed to cause circumcision by strangulating the blood supply to the distal foreskin. Necrotic tissue falls off seven to 12 days after the procedure is performed. No advantages of the Plastibell technique over other techniques have been documented, except "ease of use." Some studies have shown a small increase in the incidence of infection with the Plastibell device.

Determining the appropriate size of the device is important. A fit too small can cause tissue strangulation and necrosis, and one too large may result in too much foreskin being removed and penile denudation. Selection of the appropriate- sized Plastibell device is similar to the method used for the Gomco clamp.

After making the dorsal slit as outlined for the Gomco technique, the Plastibell device is placed on the glans and the incised foreskin is pulled over the top of it. The incised foreskin is brought over the top of the Plastibell until the apex of the incision is above the string placement guide on the device. The foreskin is clamped across the top of the Plastibell with a straight clamp.

The string is placed around the foreskin and the Plastibell device in a groove that acts as the string placement guide. The area is examined to make sure the device has not slipped out of place and the apex of the incision is distal to the placement of the string The string is then tightened and tied in a simple square knot (Figure 4a). An adequate result is obtained when the skin just distal to the string blanches without the string breaking.

The excess foreskin is trimmed from around the bell using iris scissors (Figure 4b). The handle is then broken off the device (Figure 4c).

Figure 4b.
Excision of the prepuce. Excess
foreskin is trimmed from around
the bell using an iris scissors.

Figure 4c.
Appearance of circumcision with the
Plastibell device in place.