1. Pain. The procedure is very painful without proper penile analgesia. Poor technique of penile nerve block will lead to unnecessary pain. Postoperative acetaminophen is helpful after local anesthetic wears off.
2. Infection. This is very rare (1-2/1000) with Gomco clamp. Easily treatable with oral antibiotics.
3. Minor bleeding, ~1%. Requires direct pressure and/or application of a clotting agent, e.g., microfibrillar collagen hemostat (Ativene Hemostat or Gelfoam).
4. Major bleeding, ~1-2/1000. Will require suture or bulky dressing.
5. Trauma or damage to the penis (glans, urethra, frenulum), ~<1/1000.
6. Wound dehiscence. Very rare, ~3/10,000.
7. Early termination of the procedure (rare). This is from an unrecognized penile anomaly such as hypospadias or meatomegaly that requires later repair with the prepuce. The dorsal slit should be left open and the infant referred to a pediatric urologist.
8. Poor cosmetic result. This is somewhat subjective and partly based on parental expectations. There can be excessive prepuce removal, inadequate removal or asymmetric removal. See Common Pitfalls and Problems section in Neonatal Circumcision II.