The Ministry of Health (MOH) would like to inform about the two cases of children that underwent circumcision at private General Practitioner (GP) clinics, and had resulted in complications. Both cases were subsequently referred to Kuala Lumpur Hospital (HKL) for further treatment.

The first case involved a 9 year old boy whom was first seen in Emergency Department of HKL on 15^th December 2016 at 3:34 PM. Apparently he had a circumcision procedure performed at a private GP clinic at Jalan Ipoh by a General Practitioner at 11:00 AM on the same day. The glans penis was totally amputated during the procedure using a pair of scissors. The GP had referred the child to Desa Park City Medical Centre and was subsequently referred to HKL.

In HKL, he was brought into general operation theatre for emergency surgery (exploration and replantation microsurgery). This technically very difficult surgery took about 3 ½ hours and was done on urgent basis on that same afternoon. It is important to note that there was a significant delay in the patient to reach HKL (which was beyond the control of HKL). Currently, he is still in the ward for regular wound dressing.

The second case involved a 10 year old boy was first seen in the Emergency Department HKL at 11:40 PM on 20^th December 2016. He was referred from Universiti Kebangsaan Malaysia (UKM) Medical Centre. Apparently he had a previous circumcision performed at private GP clinic 1 year ago, of which the parents were not happy with the outcome of that circumcision. Therefore, the parents brought the children to another GP at Cheras on the 20^th December 2016 where he had a ‘redo-circumcision’ procedure which was performed at 8.30pm. The glans penis was totally amputated during the procedure using a diathermy.

The boy was immediately brought to UKM Medical Centre and subsequently referred to HKL where he was brought into general operation theatre for emergency surgery (exploration and replantation microsurgery). The surgery took about 2 hours and this surgery too was technically difficult in view of the redo-circumcision technique used in this patient. He is currently still in the ward for observation.

As national referral centre, HKL specialists are trained and equipped to treat such cases. Both cases were managed by the senior experienced consultants – a team consisting of plastic and reconstructive surgeons, urologist and also child psychiatrist. Currently both patients can urinate normally. However it is too early to predict other physiological disabilities they may face in adulthood. The timing of presentation to our health facility for treatment is vital, as late presentation is associated with lesser favorable outcomes. Given the circumstances, the well-equipped, qualified and experienced surgical team at HKL had approached both cases skillfully and with their utmost dedication.

The family of both patients were kept informed of the situation of their children. Both patients will be followed up regularly by our senior consultants involved i.e. Plastic Surgery, Urology and Paediatric Psychiatry. MOH will facilitate and try our best to provide necessary assistance to both patients.

MOH is deeply concerned with the occurrence of these cases in the private GP clinics. As such, the Medical Practice Division of MOH is investigating the circumstances that led to both botched circumcision cases, and will probe further the practice of circumcision procedure done in this country to minimise the occurrence of such cases. More importantly, the MOH will not hesitate to take stern action on GPs and other health professionals that perform circumcision without the necessary training. Although this is a minor procedure, the complications can be severe and devastating for the patient. Health practitioners in both private and public health facilities need to undergo necessary training so that they can perform this procedure competently and safely.

Thank you.

DATUK DR NOOR HISHAM ABDULLAH

DIRECTOR GENERAL OF HEALTH MALAYSIA

30^th December 2016