Circumcision procedure for newborns and older boys

Circumcision is a common surgical procedure in which the foreskin covering the tip of the penis is removed. Our aim is to provide a safe, comfortable and child-friendly experience while making sure parents feel fully informed about the procedure, recovery and follow-up.

Under six months

For young infants under six months of age, circumcision can often be performed safely under local anaesthesia. This means only the area around the penis is numbed, so the procedure can be carried out without a general anaesthetic. Local numbing is usually supported with age-appropriate comfort measures such as sucrose drops for neonates and white noise for older infants.

Why families consider early circumcision

• The procedure can usually be performed under local anaesthesia.
• Recovery is generally quick.
• Babies typically return to normal feeding and sleeping soon afterwards.
• There is usually no need for fasting or hospital admission.

How the procedure is done

The procedure is usually performed as a day-case treatment. After examining your baby and confirming he is suitable for circumcision under local anaesthesia, a numbing injection is given around the base of the penis. Once the area is fully numb, the circumcision is performed using a technique appropriate for your child’s age and anatomy.

The procedure itself usually takes around 20 to 30 minutes, although families should expect to spend longer at the clinic for preparation, observation and discharge advice.

Recovery after the procedure

Most babies settle quickly after circumcision and can usually feed shortly afterwards. Mild swelling, redness and a small amount of spotting on the nappy are normal during the first few days. Healing typically occurs over 1 to 2 weeks.

• Wound care
• Nappy changes
• Bathing
• Pain relief
• Signs of possible complications
• How to contact the service for non-emergency advice

Risks and complications

Circumcision is generally very safe when performed by an experienced paediatric surgeon. However, as with any procedure, there are potential risks.

• Bleeding
• Infection
• Swelling
• Delayed healing
• Scar formation
• Cosmetic concerns requiring further treatment, which is rare

Older than one year

For children older than one year of age, circumcision is usually performed under general anaesthesia. This allows your child to sleep comfortably throughout the procedure and helps the operation be carried out safely and without distress.

Why general anaesthesia is recommended

• Complete comfort during the procedure
• A stress-free experience for the child
• Optimal conditions for a safe operation
• Excellent pain control when combined with local anaesthetic techniques

The operation

Circumcision is typically performed as a day-case operation, meaning your child can usually return home on the same day. Before surgery, your child will be assessed by both the surgical and anaesthetic teams. Once asleep under general anaesthesia, the foreskin is carefully removed and dissolvable stitches are used where necessary.

The operation itself generally takes around 30 minutes, although the overall hospital stay will be longer because of admission, preparation, recovery and observation.

Recovery after surgery

Most children recover quickly and return home a few hours after the procedure. It is normal to have mild discomfort for several days, swelling around the surgical site, redness during healing and a yellowish healing layer on the wound, which is a normal part of recovery. Complete healing usually occurs within 2 to 4 weeks.

• Pain relief
• Wound care
• Bathing
• School or nursery attendance
• Follow-up arrangements if required

Most children can return to normal activities within a couple of days, although vigorous physical activity should be avoided until healing is complete.

Risks and complications

• Bleeding
• Infection
• Swelling
• Wound healing problems
• Excessive or insufficient skin removal
• Cosmetic concerns
• Risks associated with general anaesthesia, which are uncommon in healthy children

Our surgical and anaesthetic teams take every precaution to minimise these risks and ensure the safest possible care for your child.

When to seek medical advice

Please contact your healthcare team if your child develops any of the following:

• Significant bleeding
• Increasing redness or swelling
• Fever
• Difficulty passing urine
• Severe pain not controlled by prescribed medication
• Any concerns about the appearance of the wound

Early assessment can help ensure that any problems are identified and treated promptly.

Questions from parents

We understand that choosing circumcision for your child is an important decision. We are happy to discuss the procedure, expected recovery, potential risks and any questions you may have so you can make an informed choice with confidence.

Appointments in Lahore

Paediatric Surgeon Abid Qazi is a senior paediatric surgeon with more than 30 years of experience in children’s surgery and over 20 years of experience in laparoscopic surgery. He has a special interest in circumcision. He set up two community circumcision clinics in the United Kingdom in 2008, where he performed more than 8,000 circumcisions in boys of all ages up to 18 years with 99% positive feedback from parents and families.

• Appointments in Lahore by arrangement
• Virtual second opinions available for families across Pakistan
• WhatsApp: +923174002444
• Email: info@abidqazi.com

Groin Conditions in Children

Groin and scrotal swellings are common reasons for children to be seen by a paediatric surgeon. Some are harmless and may settle with time, while others need planned treatment or urgent surgery. Common groin conditions in children include cryptorchidism (undescended testis), hydrocele, and inguinal hernia.

Cryptorchidism / Undescended Testis

Illustration guide: In an undescended testis, one testis remains higher in the groin or abdomen instead of sitting in the scrotum.

Image credit: Undescended testis illustration courtesy of urologists.org.

Cryptorchidism, also called an undescended testis, means that one or both testicles have not moved down into the scrotum. This is common in newborn boys, especially if they are born early. In some babies, the testis comes down on its own during the first few months of life. If it does not, treatment may be advised to help protect fertility and reduce later risks.

If the testis remains undescended, a paediatric surgeon may recommend an operation called orchidopexy to bring it into the scrotum and fix it in place. This is usually planned after infancy, depending on the child’s age and examination findings.

Hydrocele

Illustration guide: A hydrocele is a fluid-filled swelling around the testis. It usually causes a smooth, painless swelling in the scrotum.

Image credit: Hydrocele picture courtesy of Crazy Factor, Health and wellness on Facebook.com.

A hydrocele is a collection of fluid around the testis, causing swelling in the scrotum. It is often soft, painless, and may change in size during the day. Many hydroceles in babies improve on their own over time and can be observed in the first year or two of life.

However, if the swelling persists up to 2 to 3 years or becomes larger, your child may need a small operation to repair it. A hydrocele can sometimes be linked to an inguinal hernia, so an expert examination is important.

Inguinal Hernia in Children

Illustration guide: In an inguinal hernia, tissue such as bowel passes through an opening in the groin, creating a bulge that may come and go.

Like a hydrocele, an inguinal hernia is also a groin swelling and may look similar at first. However, unlike a hydrocele, an inguinal hernia contains tissue such as bowel or fat that passes through a small opening in the groin. This may cause a visible or felt bulge.

This may appear as a lump in the groin or scrotum. In girls, a hernia may appear as a swelling in the groin or labial area. The swelling may come and go, often becoming more noticeable when a child cries, coughs, strains, or is active, and may disappear at other times. Unlike many hydroceles or an umbilical hernia, an inguinal hernia does not usually go away by itself and requires surgery to close the opening and prevent complications.

Emergency note: An obstructed inguinal hernia is an emergency and can be life threatening if treatment is delayed. Seek urgent medical care if the swelling becomes painful, firm, red, cannot be pushed back in, or if your child has vomiting, abdominal swelling, distress, or seems unwell.

Parents should seek urgent medical help if the lump becomes painful, firm, red, cannot be pushed back in, or if the child has vomiting, abdominal swelling, distress, or appears unwell, as this may suggest that the hernia is trapped. Usually an inguinal hernia is treated with surgery within a few weeks of diagnosis because trapped bowel or compromised blood flow can cause damage in an infant.

Laparoscopic Hernia and Hydrocele Repair

Both inguinal hernia and hydrocele can be repaired using minimal access technique which leaves no scar after surgery. Recovery is fast and children to return home the same day. I have been performing laparoscopic surgery for the last twenty years with excellent results.

When to Seek Medical Advice

Please arrange a medical review if you notice a persistent groin or scrotal swelling, if one testis seems absent from the scrotum, or if a swelling becomes painful, red, or hard. Early assessment helps clarify whether observation, planned surgery, or urgent treatment is needed.

Treatment for Groin Conditions in Lahore

Paediatric Surgeon Abid Qazi is a senior paediatric surgeon with more than 30 years of experience in children’s surgery and over 20 years of experience in laparoscopic surgery. He assesses groin conditions in children, including hydrocele, inguinal hernia, and undescended testis, and advises parents on the safest timing and type of treatment.

• Appointments in Lahore by arrangement
• Virtual second opinions available for families across Pakistan
• WhatsApp: +923174002444
• Email: info@abidqazi.com

If you are concerned about a groin swelling, hydrocele, hernia, or undescended testis in your child, please seek specialist advice early.

Acute Appendicitis in Children

Acute appendicitis is a sudden inflammation of the appendix and is considered a surgical emergency. The appendix is a small blind pouch attached to the large intestine on the lower right side of the abdomen. Its exact purpose is not fully understood, so it can be safely removed when appendicitis occurs.

What is appendicitis?

Acute appendicitis can develop in stages:

• Obstruction
• Inflammation
• Ulceration and gangrene
• Perforation

It most commonly affects children between 8 and 11 years of age, although it can occur at any age. Symptoms may vary from child to child.

Common symptoms

• Pain that starts around the belly button and then moves to the lower right side of the abdomen within a few hours
• Loss of appetite
• Nausea
• Vomiting
• Fever, which is often a later sign

Clinical diagnosis can sometimes be challenging because the appendix can lie in different positions in the abdomen. During assessment, the doctor may perform specific clinical tests to support the diagnosis.

• Pressing on the tummy in specific areas
• Moving the leg in certain ways
• Hop sign, where the child is asked to jump or the area under the right heel is gently tapped with the leg extended

Imaging tests

Imaging is not necessary in every case, but an ultrasound scan or CT scan may be used to support the clinical diagnosis when needed.

Management

Treatment depends on whether the appendicitis is simple or complicated, and also on how long the symptoms have been present.

Simple appendicitis

• Initial treatment includes pain relief and antibiotics
• Appendicectomy is the definitive treatment
• When there is a short history and no perforation, surgery can often be done promptly

Complicated appendicitis

• With perforation and a short history, IV fluids and antibiotics are usually started first
• Appendicectomy may be performed after clinical improvement
• With a longer history and an appendix mass, conservative treatment may be advised first, followed by interval appendicectomy after around 3 months
• If there is no clinical improvement, surgery becomes necessary

Surgical options

Open surgery is now almost obsolete in many cases. Laparoscopic surgery is commonly used and usually involves three small incisions for the camera and instruments.

SILS, or single-incision laparoscopic surgery, is a further advancement. It uses one incision through the belly button, which can offer better cosmetic results.

There are two main SILS techniques:

• Intracorporeal SILS appendectomy, where the procedure is completed inside the abdomen using laparoscopic instruments
• Exteriorisation technique, where the appendix is delivered through an umbilical incision and removed outside the abdomen, similar to a mini open operation

Advantages of SILS

• Faster recovery after surgery
• A single small incision hidden under the belly button for a better cosmetic outcome

Possible challenges of SILS

• A learning curve because the technique is newer and more specialised
• Instrument crowding through a smaller incision, which can make the operation technically more demanding

SILS in Lahore

Dr. Abid Qazi is a senior paediatric surgeon with more than 30 years of experience in paediatric surgery. He has used SILS as a standard technique for many paediatric procedures, including appendicectomy, and has helped many children recover successfully.

He is available for in-person consultations in Lahore as well as virtual consultations and second opinions. To request an appointment, please email info@abidqazi.com, send a WhatsApp message to +92 317 4002444, or visit the Contact page.

Early assessment can make a real difference in children with suspected appendicitis.