Pediatric Surgery International (2018) 34:803–806
Outcomes of circumcision in children with single ventricle physiology
Joseph A. Sujka
· Richard Sola Jr.
· Amy Lay
· Shawn D. St. Peter
Accepted: 23 May 2018 / Published online: 29 May 2018
© Springer-Verlag GmbH Germany, part of Springer Nature 2018
Purpose Children with single ventricle physiology (SVP) have been shown to have a high morbidity and mortality after
non-cardiac surgical procedures. Elective circumcision is one of the most common pediatric operations with low morbidity
and mortality. The purpose of our study was to review our institutional experience with SVP children undergoing circumci-
sions to determine peri-operative course and outcomes.
Methods We performed a retrospective review of children with SVP who underwent an elective circumcision from 2000 to
2017. Children with non-single ventricle physiology or children undergoing circumcision in combination with another case
were excluded. Demographics, surgical characteristics, and outcomes were analyzed. Descriptive statistics were performed,
all medians were reported with interquartile range.
Results 15 males underwent elective circumcision with a median age at the time of surgery of 1.13 (1.03, 1.38) years. Eighty-
four percent underwent their circumcision after their 2nd stage cardiac operation. Most common operative indication was
uncomplicated phimosis. Median operative time was 20 (16, 27) mins. Median total length of stay was 229 (185, 242) mins
with no admissions. Post-operative complications included two (16%) hematomas with one requiring surgical intervention.
There were no deaths.
Conclusion Children with SVP who undergo elective circumcision may have a higher risk of bleeding.
Keywords Congenital heart disease · Circumcision · Hypoplastic left heart syndrome
Circumcision is one of the most common procedures for
male infants and children . The complication rate is
between 2 and 10%, with the most common complications
including hematoma and infection . Circumcision has a
very low morbidity rate with < 1% of patients requiring read-
mission or reoperation .
Children with single ventricle physiology (SVP), espe-
cially hypoplastic left heart syndrome (HLHS), often require
additional surgeries after their initial cardiac operation such
as gastrostomy tube placement and tracheostomy. The litera-
ture has shown that these children have a high morbidity and
mortality after major non-cardiac surgical procedures due to
their delicate cardiac physiology and their increased risk of
hemodynamic instability [4–9]. Recent literature suggests
these children can live up to two decades . Given their
increased peri-operative risk, our institution completes a
thorough assessment by anesthesia, a cardiologist, and both
general and cardiac surgeons prior to any elective or cos-
metic procedures, such as a circumcision.
The purpose of our study was to review our institutional
experience with SVP children undergoing circumcisions to
determine their peri-operative course and outcomes. Given
the known increase in operative mortality for SVP patients
for more invasive procedures, we hypothesized that there
would also be an increase in morbidity with children under-
* Shawn D. St. Peter
Joseph A. Sujka
Richard Sola Jr.
Department of Surgery, Children’s Mercy Hospital, 2401
Gillham Road, Kansas City, MO 64108, USA