At what age range should children be circumcised?

Background: Although male circumcision is a surgical intervention that is frequently performed in children, there is no consensus about the age at which it should be performed.

Objectives: The purpose of this study was to determine the best age range for routine male circumcision with respect to a child's health and the cost.

Patients and methods: This clinical trial was conducted in the affiliated hospital of the Erzincan University of Medical Sciences, Turkey, in 2014. The circumcised children were evaluated in 3 groups: < 1 year old (Group 1), 1-7 years old (Group 2), and > 7 years old (Group 3). To obtain a satisfactory Wilton sedation score, midazolam 0.1 mg/kg IV was administered first. If adequate sedation was not achieved, ketamine 2 mg/kg IV was also administered. If adequate sedation was still not achieved, general anesthesia was administered via a laryngeal mask. At the end of the surgery, the groups were compared in terms of post-anesthesia recovery duration, complications, discharging duration, and cost.

Results: A total of 603 children were circumcised, 374 in Group 1, 94 in Group 2, and 135 in Group 3. Midazolam was sufficient for sedation in 364 Group 1 patients (97.3%), 6 Group 2 patients (6.3%), and 38 Group 3 patients (28.1%). The shortest post-anesthesia recovery duration after surgical intervention and time until discharge, the lowest cost, and the fewest anesthesia complications were observed in Group 1 (P < 0.05 for all).

Conclusions: Although almost all of the < 1 year-old children could be sedated with midazolam alone, most of the > 1 year-old children required ketamine or general anesthesia. Performing circumcision when children are less than 1 year old decreases the risk of complications due to anesthesia and lowers the costs compared with performing the procedure on older children.