Procedure Preparation & Recovery

• Check-in 30-60 minutes before your appointment time.
• Review circumcision consent. Dr. Akil will review with you prior to performing the procedure.
• Your son can eat 1 hour prior to the procedure.
• Call ahead of time to provide your son's health card and date of birth.
• Parents bring your picture ID (must match the baby).
• No siblings. No exceptions (Please arrange for childcare).
• Bring infant Tylenol and Neosporin ointment to the appointment.
• Bring a diaper, baby wipes, blanket, pacifier and bottle.
• If you need to reschedule, call our office 72 hrs before.

• Check-in with the staff at reception.
• Parents and son will meet Dr. Akil who will then explain the procedure and possible complications.
• Dr. Akil will discuss consent and answer any questions about circumcision.
• Parents will be given time to decide if Dr. Akil and the Mogen Clamp technique is the right choice for their son.
• Once decided Dr. Akil will prep the child for surgery and the genital area will be sterilized with antiseptic.
• The administration of local anesthesia and circumcision will take place.
• Finally, you are also welcome to be present for the circumcision if you wish.
• No pictures or videos are allowed during the procedure, please.

Please read the post-procedure care instructions carefully and don't hesitate to ask our team if you have any questions.

• To prevent infection, be sure to wash your hands before and after you remove the gauze and when applying Vaseline or Polysporin.
• Leave your infant's dressing (lubricant gauze) on for 24 hours after the circumcision.
• Check for bleeding every hour for 24 hours.
• If the gauze is stuck to the circumcised area, wet the gauze with warm water to loosen it and gently remove it.
• If gauze falls off while changing diapers before 24 hrs, no gauze is required, only ointment.
• While your child is healing, apply a very small amount of Fucidin around the incision site four times a day for 7 days.
• Once Fucidin is applied, then a petroleum-based ointment (such as Vaseline or Polysporin) should be applied from the tip of the penis to the incision site after every diaper change for 14 days. This will prevent infection and the penis from sticking to the diaper.
• Give Tylenol every 4-6 hrs according to the child weight as needed for discomfort for 3-5 days.
• If the circumcised area becomes soiled with stool, gently wash the stool off penis with warm water and a clean cloth if needed.
• Do not use soap, lotion, powder or diaper wipes to clean the penis because they may cause stinging or irritation.
• Diapers should be changed right after urination/bowel movement and Vaseline or Polysporin should be applied to the end of the penis.
• Buried Penis: Some boys may have a large suprapubic fat pad, the penis may sink back inside pushing the skin upwards covering the head of the penis. This requires the caregiver to press on either side of penis to expose the head and prevent post circumcision adhesions and phimosis by applying vaseline around the head of the penis.
• Allow the penis to heal by avoiding bathing or wiping for 5 days.
• Dr. Akil will follow up over the phone a few hours after the procedure.
• Follow-up Appointment in 2 weeks. If adhesions occur they will be released during follow-up free of charge.

Over the following days, your child will heal from the surgery in stages. Every child heals differently; it can take up to a month for the penis to appear fully healed.

• Bleeding: Stops Within Seconds to minutes after procedure.
• The cut edges of the glans close up.
• Colour changes: Immediately after the circumcision, the glans may appear red and glossy or even purple. This occurs because the skin covering the glans of an uncircumcised penis is a mucous membrane. Once the membrane is exposed, it thickens and becomes darker. Your child's gland may have off-white or yellowish patches in the first few days after surgery. These are a type of scab and are completely normal. Two or three days after the circumcision, the skin may look green and yellow. This is a sign of normal healing, not pus.
• Swelling: You may notice some swelling behind or under the head of the penis and believe it looks like a blister. The swelling is simply another sign of healing and will disappear within a week or two.
• Changes in size: The penis may appear smaller after circumcision. This is mostly because the skin surrounding the penis is relaxed, while before circumcision it usually held the penis more erect.

If you notice any of the following please seek medical care immediately by contacting TOCC or going to the nearest emergency department:

• There is bleeding from the circumcision area that continues to soak through the gauze.
• Your child has not urinated within 24 hours after the circumcision.
• Your child's redness or swelling around the circumcised area gets worse after three to five days.
• Your child's penis is blue or black.
• Your child's temperature is over 100.4°F.
• Your child has an unpleasant-smelling, yellowish-green discharge from the penis.