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Objective: To demonstrate how an erroneously taught and practiced procedure can be addressed and ameliorated by both discernment of the underlying problem and appropriate reeducation of erring clinicians.
Design: We reviewed the charts of 32 consecutive patients who were referred to the senior author between 2009-2012 for circumcision revisions.
Setting and Patients: All of the circumcisions had been performed de novo by an MD either from the pediatrics service (n=12) or the Obstetrical service (n=20) of our Children’s Hospital. No non-physician professionals were involved in these cases.
Intervention: All of the revisions were performed with a sleeve resection by the senior author. The technique used was filmed and placed on our hospital’s internal web site for reeducation of the clinicians performing these operations. The ages at the time of revision ranged from 10 weeks to 12 years of age.
Results: All 32 revisions were done with satisfactory results. All parents were interviewed and content with the revisions. In all of the revisions the common finding was an intact frenulum.
Conclusion: We found that the technique for circumcision was flawed at our institution. It was a technique that had been taught among a small group of clinicians working in the same area and for the same institution for many years. This promulgation of a poor technique had dire consequences both surgically and economically for the children of our small state. We have shown that by circumspect evaluation of a recurring problem and collegial reeducation of erring practitioners, one can address poor surgical results without rancor through a video instructional course.