The “ARM” principle and practice: Preventing postoperative complications of circumcision

Background: As one of the most commonly performed surgical procedures, circumcision may lead to complications. However, studies on preventing postoperative complications are scarce and still insufficient to draw any conclusions. This retrospective study aimed to summarize the surgical principles and consideration for preventing complications after circumcision. Methods: We reviewed 28 patients (aged 3–45 years; median age, 24 years) with prepuce hyperplasia or phimosis treated with our modified circumcision technique. In our modified technique, an accurate incision design is made through the stretch test, the stenosis is released, and veins and lymphatic tissues in the fascia are maintained. These surgical details for preventing complications were abbreviated to “ARM.” Results: None of the patients had complications at the 6-month follow-up postoperatively. Only mild prepuce edema was observed, which returned to the normal condition spontaneously within 2–3 weeks. The diameter of the distal penis increased by 0.4 ​± ​0.1 ​cm 6 months after the procedure. Conclusion: The “ARM” principle may help surgeons to prevent postoperative complications of circumcision. Maintaining the fascia during the procedure can increase the diameter of the surgical region.