Article Type : Review Article
Authors : Muhammet Mesut Nezir Engin
Keywords : COVID-19; Circumcision; Child
Since the end of December 2019, the outbreak of COV?D-19
disease has affected the city of Wuhan in China, and then the whole world. As
of August 3, nearly 18 million cases have been confirmed and more than 689
thousand deaths. For religious, traditional and medical reasons, currently the
most common surgical intervention in the worldwide is circumcision. In this
review, the issues regarding whether circumcision is performed during the
COVID-19 outbreak are discussed, and if the circumcision is necessary, the
measures to be taken are described in items. No publication was provided
encountered in the literature regarding the condition of circumcision in the
outbreak of COVID-19. It is the first publication on this subject.
Since the end of
December 2019, the outbreak of a new coronavirus disease (COVID-19; previously
known as 2019-nCoV) has affected the city of Wuhan in China, and then the whole
world. Severe disease onset can result in death due to large alveolar damage and
progressive respiratory failure. The average mortality rate in COVID-19
patients is 2%. As of August 3, nearly 18 million cases have been confirmed and
more than 689 thousand deaths. The number of daily deaths approached 5 thousand
[1-4]. Circumcision; It is the excision of the prepuce to reveal the glans
penis. Undisputed is the oldest known surgical procedure. For religious,
traditional and medical reasons, currently the most common surgical
intervention in the worldwide is circumcision. Therefore, the interest in
circumcision continues continuously. When we look at the literature about
circumcision, we came across those who were circumcised or who were against it.
Although there are discussions about routine circumcision, circumcision is
still performed for certain reasons. However, in most countries, circumcision
is performed under hospital conditions [5-6]. In the COVID-19 outbreak,
restrictions were imposed on emergency and non-mandatory routine practices. In
many countries, elective surgeries have been cancelled or postponed. No
publication was provided encountered in the literature regarding the condition
of circumcision in the outbreak of COVID-19. It is the first publication on
this subject. Circumcision practices for religious and traditional reasons
should be postponed due to the outbreak of COVID 19. Postponing the
circumcision is the most correct approach. Routine circumcision is not
recommended between the ages of 2-6, as children may develop psychological
trauma. Sometimes, families can insist on circumcision as children grow up and
the psychological trauma age range approaches. The infection control measures
to be taken for medical reasons or during routine circumcision in the COVID-19
outbreak are listed below.
Pre-circumcision
evaluation and preliminary
•
Firstly,
it is recommended to postpone elective circumcision procedures.
•
All
patients and their relatives should be informed about the use of masks during
the application.
•
Patients
should be questioned for signs of COVID-19 at admission.
•
Patients
with fever and respiratory symptoms should be directed to the relevant
departments at the time of admission.
Precautions to be taken in the transfer
process and operating room
•
The
route of the patient should be defined in advance, be short, and away from
other patient and hospital departments and general areas.
•
The
stretcher should be cleaned and disinfected after each patient. 1/100 diluted
bleach or chlorine tablet is used for cleaning. For this purpose, 70% alcohol
can also be used. It is ensured that the disinfectant remains on the cleaned
surface for at least 1 minute.
•
The
staff assigned for the transfer must have received training on this subject.
•
Staff
should ensure hand hygiene before transfer and with patients should minimize
contact.
•
All
patients should be wearing medical masks.
•
Operating
room staff should question themselves every day for COVID-19 symptoms and
contact history. The person with the symptoms should inform the supervisor.
•
It
is more appropriate to perform circumcision with local anaesthesia.
•
If
general anaesthesia is to be performed, intubation should be performed in the
operating room, and personnel other than the necessary personnel should be
outside the operating room until the anaesthesia induction and intubation is
completed.
•
The
whole team who will participate in the circumcision must be in the room on
time, and the surgery should not leave before the end.
•
Instruments
that are not required for circumcision should not be kept in the operating
rooms.
•
Disposable
materials should be preferred.
The least necessary material should be used for
each case. If a material is required from outside the operating room, an
external staff should be brought in.
During the circumcisions made for religious and
traditional reasons, ceremonies attended by many people are held. Certainly, no
ceremony should be held due to the outbreak of COVID-19.
Circumcision practices should be postponed in the
COVID-19 outbreak. If circumcision is required, it is vital to take certain
precautions.