Date of Award


Document Type


Degree Name

Master of Medicine (MMed)

First Supervisor/Advisor


Second Supervisor/Advisor



General Surgery (East Africa)


Introduction: Circumcision is one of the oldest and most common surgical procedures in the male population. Of the various circumcision techniques, sutures and tissue glue are utilized for wound closure in the free-hand techniques. Locally, sutures are routinely used for wound closure in the free-hand techniques. Whilst there are studies comparing the two wound apposition techniques using various outcomes, pain as a primary outcome comparing the two has been poorly researched. One hypothesis is that local ischemia at the suture site contributes to post-circumcision pain. It is against this background that we sought to explore differences in pain between these two methods of wound apposition.

Method: This was a prospective randomized controlled trial comparing post-operative pain following tissue glue and suture wound apposition post-circumcision. Secondary objectives were to establish the difference in post-operative bleeding, wound dehiscence and duration of surgery between the two interventions. Eligible participants were male children between 2 and 12 years coming for circumcision at the Aga Khan University Hospital, Nairobi from September 2021 to April 2022. They were allocated into the two intervention arms of sutures versus tissue glue following simple randomization. Duration of surgery was noted in the operation notes and populated in the data sheet. At 24 and 48 hours post-operatively, the Parents Post-Operative Pain Measure questionnaire was administered telephonically to assess pain. A pain score of more than or equal to 6 out of 15 was considered clinically significant. Outcomes of bleeding and wound dehiscence were obtained at the post-operative clinic review and populated on the data sheet. A small sample analysis was done. Continuous data was expressed as means ± standard deviation and differences between groups were assessed using the student’s t-test.

Results: Eighteen patients were analyzed in the present study with twelve in the suture arm and six in the tissue glue arm. The mean age of the participants was 6 ½ years (Range 2- 11years, SD 2.55). The mean level of pain at 24 hours was 1.3 (SD 1.55) and 0 at 48 hours. There was a statistically significant difference in pain in patients with suture apposition compared to glue apposition (t (16) = 2.066, p = 0.045). This was, however, not clinically significant given as the mean level of pain was less than the clinically significant level of 6 as indicated on the Parents Post-Operative Pain Measure questionnaire. There was no bleeding noted in either groups at one week. Wound dehiscence was noted in one patient in the glue apposition group. However, this was not statistically significant when the two groups were compared (t (16) = 1.46, p = 0.16). The mean duration of surgery in the glue group was found to be slightly longer compared to the suture group (26.5 versus 21.3 minutes). However, this did not reflect a significant statistical difference (t (16) = -1.418, p = 0.175)

Conclusion: In view of the limited sample size, the present study’s results may not be generalizable. The trends from the small sample analysis suggests that despite there being a statistically significant difference in pain, there was no clinically significant difference in post-operative pain during the first 24 – 48 hours, with more patients complaining of pain in the suture apposition group. The trends in the present study similarly demonstrated no statistically significant difference in post-operative bleeding rates, duration of surgery as well as wound dehiscence rates between the two groups.

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