Is There a Preferred Surgical Intervention for Symptomatic Bartholin’s Cyst?
BACKGROUND AND PURPOSE:
Illingworth et al. (BJOG, 2019) performed an
updated systematic review and meta-analysis to assess the safety and efficacy
of surgical interventions for a symptomatic cyst or abscess of the Bartholin’s
Interventions including: Marsupialization | Incision,
drainage and insertion of a Word catheter | Incision, drainage and silver
nitrate | Cyst excision | Alcohol
Marsupialization was not significantly better than
a Word catheter
Word catheter: Recurrence risk ratio (RR) 0.76 (95%
CI, 0.41 to 1.40)
Incision, drainage and silver nitrate insertion:
Recurrence RR 1.00 (95% CI, 0.57 to 1.75)
Incision, drainage and cavity closure: Recurrence
RR 0.25 (95% CI, 0.01 to 4.89)
Reporting of secondary outcomes (hematoma,
infectious morbidity and persistent dyspareunia) was limited
None of the surgical interventions that were
analyzed in this meta-analysis demonstrated superiority in terms of recurrence
or other morbidities
Authors recognize limitation of the study,
including small ‘n’ for some interventions and outcomes leading to imprecise
estimates of differences in recurrence rates
The authors suggest that consideration be given
to Word catheter due to the following advantages
…the ability to undertake the procedure within an office setting, the avoidance of general anaesthesia, and reductions in resource utilisation such as hospital beds and usage of operating theatre time
Women should be informed of the difference in pain intensity during the first postoperative day, with women reporting increased pain intensity following Word catheter insertion when compared with marsupialisation
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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