You should take your kids to paediatric surgeons for circumcision. Here's why

Two children have tragically lost their lives during circumcision procedures at two private hospitals in Dhaka within just six weeks. On both occasions, it has been alleged that both children died due to general anaesthesia performed by surgeons and anesthesiologists for adults.

Paediatricians said the deaths are happening due to circumcisions not being performed under a skilled team of paediatric surgeons. They suggested parents refer to skilled paediatric surgeons and anesthesiologists for their children's circumcision in good facilities.

Dr Abdul Hanif, a professor of Neonatal and Paediatric Surgery at Dhaka Medical College Hospital, told The Business Standard that paediatric surgery needs a proficient team of paediatric surgeons and anesthesiologists, along with proper patient management and adequate anaesthesia equipment.

Patient preparation is important, the surgeon said, adding that it is important to check whether the child has asthma or any other illness.

Dr Hanif said he has been performing circumcisions at Dhaka Medical College since 1995. "In 90% of cases, circumcisions were done using general anaesthesia, and so far, there have been no fatalities. Even in complex cases, complications were managed.

"Globally, the risk of anaesthesia-related death is 1 in 1,00,000 patients undergoing any surgery, whereas in our country, it stands at 1 in 10,000."

Dr Mohammad Mahbubul Alam, assistant professor of Paediatric Surgery at Cumilla Medical College Hospital, told TBS that a child is different from an adult physiologically, anatomically, and psychologically.

"Therefore, a surgeon or anaesthesiologist who is great with adults might not be as good with children. Children need different doses of medicine, so paediatric doctors need specialised skills," he added.

On 8 January, five-year-old Ayaan Ahmed died after undergoing circumcision under full anaesthesia at the United Medical College Hospital in Dhaka. Ayaan's father alleged that his son died due to negligent treatment while being kept on life support for seven days.

Another child, 10-year-old Ahnaf Tahmin Ayham, died on Tuesday night allegedly due to the administration of general anaesthesia during a circumcision procedure. This time, it was at the JS Diagnostic and Medical Checkup Center in Malibagh, Dhaka.

Doctors said during school closures, particularly in January and February, there is an increase in the number of circumcisions performed on children. 

At Dhaka Medical College Hospital, during school holidays, 10-20 procedures are conducted daily. These surgeries are outpatient procedures, meaning patients are not admitted and can leave after the surgery, known as day care surgery.

Doctors also observed that there are fewer instances of fatalities during circumcision or similar surgeries in government hospitals, medical colleges, or private hospitals equipped with paediatric surgery departments.

Parents need to be careful

Before any surgery, it's important to fast for four hours. Sometimes, parents forget to tell the doctor if their child has eaten something during this time, which can lead to accidents, several doctors told TBS.

Therefore, they said parents must provide all the necessary information to the doctor.

Dr Alam said after the recent accidents during circumcision, some suggest opting for traditional circumcisers. "However, they too have complications, and some cases even result in fatalities. Unfortunately, these cases often go unreported as they involve children from poor families."

He said parents should ensure that their child is taken to a paediatric surgeon and anesthesiologist for circumcision. "Fortunately, Bangladesh now has an adequate number of such doctors." 

Professor Dr Debabrata Banik, Department of Anaesthesia, Analgesia and Intensive Care Medicine, BSMMU told TBS that 90% of circumcisions on children are performed under general anaesthesia. 

"Children may not express their issues well or cooperate during surgery, so we usually give general anaesthesia. This helps the surgeon work smoothly while keeping the child pain-free," he said. 

However, children need specialised expertise, he added. Before any procedure, thorough investigations are necessary to check for any medical conditions or medication allergies.