Safety, Complications, and Procedural Efficiency of Neonatal Circumcision Devices: A Network Meta-Analysis.

Abstract

PURPOSE: This study aims to compare safety, complications, and procedural characteristics of commonly used circumcision devices in neonates and early infants. METHODS: We searched PubMed, EMBASE, Web of Science, and SCOPUS through January 2026 for randomized controlled trials comparing infant circumcision devices (Plastibell™, Mogen™, ShangRing™, AccuCirc™) in infants ≤3 months. The primary outcome was total adverse events; secondary outcomes included bleeding, infection, redundant skin, adhesions, parental satisfaction, and procedure time. A random-effects network meta-analysis estimated relative effects with 95% confidence intervals (CI), using Gomco™ or Mogen™ as reference devices. Analyses were performed in R. RESULTS: Ten trials including 3,984 infants from Africa, the Middle East, and the United States were analyzed. No device differed significantly from Gomco™ in total adverse events: Plastibell™ (risk ratios, [RR] 1.53, 95% CI 0.56-4.21), ShangRing™ (RR 2.70, 95% CI 0.31-23.66), Mogen™ (RR 3.83, 95% CI 0.97-15.17), and AccuCirc™ (RR 9.62, 95% CI 0.24-388.45). Plastibell™ was associated with a higher infection risk versus Gomco™ (RR 4.25, 95% CI 1.43-12.65). No significant differences were observed in bleeding, redundant skin, adhesions, or parental satisfaction. Mogen™ and ShangRing™ had shorter procedure times than Gomco™ (mean difference [MD] -3.29 minutes, 95% CI -4.82 to -1.76; MD -3.39 minutes, 95% CI -6.11 to -0.67). CONCLUSIONS: Neonatal circumcision devices demonstrate generally comparable safety profiles, though Plastibell™ carries elevated infection risk. Mogen™ and ShangRing™ offer procedural efficiency advantages. Device selection should prioritize provider expertise, infection control capabilities, and programmatic efficiency requirements alongside safety considerations.