Treatment of Bartholin's abscess. Marsupialization versus incision, curettage and suture under antibiotic cover. A randomized study with 6 months' follow-up

Evaluation of treatments for Bartholin's cyst or abscess: a systematic review

BACKGROUND

No consensus on the management of symptomatic cysts or abscesses of the Bartholin's gland exists.

OBJECTIVES

To assess the effectiveness and safety of surgical interventions for a symptomatic Bartholin's cyst or abscess.

SEARCH STRATEGY

We searched bibliographical databases from inception to April 2019.

SELECTION CRITERIA

Randomised trials evaluating a surgical intervention for the treatment of a symptomatic Bartholin's cyst or abscess.

DATA COLLECTION AND ANALYSIS

Eight trials, reporting data from 699 women, were included. Study characteristics and methodological quality were recorded for each trial. Summary estimates were calculated using random-effects methods.

MAIN RESULTS

When considering the recurrence of a symptomatic Bartholin's cyst or abscess, the evidence was consistent with notable effects in either direction (risk ratio [RR] 0.76; 95% confidence interval [CI] 0.41-1.40) when comparing marsupialisation with incision, drainage and insertion of a Word catheter. Limited inference could be made when comparing marsupialisation with incision, drainage and silver nitrate insertion (RR 1.00; 95% CI 0.57-1.75), and incision, drainage and cavity closure (RR 0.25; 95% CI 0.01-4.89). There was limited reporting of secondary outcomes, including haematoma, infectious morbidity and persistent dyspareunia.

CONCLUSIONS

Current randomised trial evidence does not support the use of any single surgical intervention for the treatment of a symptomatic cyst or abscess of the Bartholin's gland.

PROSPECTIVE REGISTRATION

PROSPERO: International Prospective Register of Systematic Reviews; CRD42018088553.

TWEETABLE ABSTRACT

Further research is needed to identify an effective treatment for #Bartholin's cyst or abscess. @jamesmnduffy.

The impact of CO2 laser for treatment of Bartholin's gland cyst or abscess on female sexual function: a pilot study

The aim of this study is to evaluate the sexual functionality before and after treatment of Bartholin's gland diseases (BGD) with CO₂ laser and to compare our results to patients who underwent surgical cold knife and to a healthy control group (HCG). Consecutive patients (n = 15) affected by BG cyst or abscess who underwent CO₂ laser treatment were evaluated. Patients were asked to complete the Italian translation of the Female Sexual Functioning Index (FSFI) before and 4 weeks after treatment. Results after CO₂ laser were compared with two control groups: patients affected by BG cyst (n = 15) or abscess treated with surgical cold knife treatment and a HCG (n = 18). A statistically significant advantage of CO₂ laser versus cold knife treatment in terms of lubrication, pain and global score were recorded. Both the single scores of five domains and total score of FSFI were globally higher after any treatment compared to before (CO₂ and cold knife) of BGD. According to our data, CO₂ laser therapy is often well tolerated by patients and correlated with a favorable sexual health recovery.

CO2 laser treatment for Bartholin gland abscess: ultrasound evaluation of risk recurrence

STUDY OBJECTIVE

To evaluate the efficacy of CO2 laser treatment and parameters correlated with recurrence in patients with Bartholin gland abscesses treated using this approach.

DESIGN

Prospective study (Canadian Task Force classification II-2).

SETTING

University hospital.

PATIENTS

One hundred forty-seven patients who met eligibility criteria.

INTERVENTION

Preoperative ultrasound evaluation of Bartholin gland lesions and CO2 laser treatment.

MEASUREMENTS AND MAIN RESULTS

All patients received CO2 laser therapy, with median operative time 15 minutes (range, 12-35 minutes). Median postoperative stay was 1 hours (range, 1-4 hours). Estimated 3-year relapse-free rate was 88.56%. Lesion wall thickness 0.5-1.5 mm, multilocular lesion, and hyperechogenic lesion were correlated with recurrence.

CONCLUSION

CO2 laser of Bartholin gland abscesses could be a valid option. Ultrasound characteristics of Bartholin gland lesions could predict lesion recurrence rate.

Novel technique for management of Bartholin gland cysts and abscesses

BACKGROUND

Definitive methods for treatment of a Bartholin cyst and abscess include placement of a Word catheter, marsupialization, application of silver nitrate, and surgical excision. Placement of a Word catheter is the most frequently employed technique for office and emergency department (ED) management. However, many institutions do not have the Word catheter available; in addition, the catheter has a tendency to dislodge before epithelialization, leading to recurrence of the cyst.

OBJECTIVE

We have developed a simple technique for management of Bartholin gland abscess or cyst using readily available materials. This technique involves using a small loop of plastic tubing, which is secured to prevent expulsion before epithelialization of a drainage tract.

CASE REPORT

A 25-year-old woman presented to the ED with a Bartholin gland abscess. After administration of local anesthetic, a loop of tubing was placed, allowing for drainage of the abscess. The patient was discharged home with a course of oral antibiotics. At 3-week follow-up, the Bartholin gland abscess was found to be healed; the device was removed without difficulty, leaving two drainage tracts.

CONCLUSION

This technique may be used as an alternative to placement of a Word catheter for management of Bartholin gland abscess or cyst.

[Postoperative complications of Bartholin's duct abscess. About two cases]

Bartholinitis is the most common infectious vulvar disease and develops in approximately 2% of all women. The choice concerning treatment may be uneasy between medical or surgical modalities, and we have to be cautious because of the risk of severe complications associated with the procedure. We report two cases: one case of sepsis and the other one of bacterial cellulitis after Bartholin's duct abscess marsupialization. In the light of epidemiological and bacteriological date referring to Bartholinitis, we recommend a safe and effective management (particularly the use of broad-spectrum antibiotics) that we will describe.

Aspiration and alcohol sclerotherapy: a novel method for management of Bartholin’s cyst or abscess

OBJECTIVE

To investigate the efficiency and safety of alcohol sclerotherapy of Bartholin's cyst or abscess by comparing it with silver nitrate insertion.

STUDY DESIGN

Twenty-two patients with unilateral Bartholin's cyst or abscess were randomized into one of the treatment groups according to diameter of cyst or abscess. Group I consisted of 12 patients who were treated with alcohol sclerotherapy and Group II included 10 patients who were treated with silver nitrate insertion. In both groups, treatments were conducted under local anesthesia and in an outpatient setting. The patients were checked for morbidity of operations every 3 days until complete healing was observed and then followed up monthly for over 24 months.

RESULTS

The mean duration of procedure was 7+/-2 min in group I and 15+/-3 min in group II. Healing time was 4.8+/-1.3 days in group I and 9.2+/-2.5 days in group II. In group I although 10 patients showed complete healing without any early or late morbidity; two patients suffered from severe vulval pain, edema and echymosis, and then developed a total cyst necrosis. Healing in these patients completed with mild scar formation. Only one recurrence was documented during 24 months follow-up period. All patients in group II complained labial pain, four of them suffered from severe labial pain, edema, and echymosis. Healing in these patients was completed with moderate scar formation. Follow-up of 24 months revealed no recurrence in this group.

CONCLUSION

Alcohol sclerotherapy of Bartholin's cyst or abscess is as effective as silver nitrate application and is associated with less complication. It may be ideal, safe and attractive treatment modality for this gynecological disease.

Treatment of Bartholin's cyst and abscess: excision versus silver nitrate insertion

In a prospective randomized study, intracavitary silver nitrate (AgNO3) stick insertion (n = 25) was compared to the conventional excision technique (n = 25) for Bartholin's cyst or abscess. Two groups were similar with regard to age, previous Bartholin's cyst/abscess and size of the cyst. Operation and healing time was significantly shorter in the AgNO3 group (P < 0.001, P < 0.001, respectively). Chemical burning in the vulva was observed in one patient in the AgNO3 group, whereas hematoma on the operation site occurred in two patients in the excision group. Scar formation was found in two patients in whom excision was performed. Patients were followed for a period of 2 years and recurrence was not found in any of the cases in both groups. We conclude that, AgNO3 insertion treatment for Bartholin's cyst and abscess is as effective as excision and is associated with fewer complications. Because it is simple and inexpensive, it is an attractive alternative treatment modality for this common gynecological disease.

Outpatient management of Bartholin gland abscesses and cysts with silver nitrate

This study reports results of 52 patients with Bartholin abscesses or cysts who were managed by silver nitrate stick insertion into the cyst or abscess cavity for 48 hours. All patients showed complete healing within 15 days. However, 2 (3.8%) had recurrences within the first 2 months; 1 of these patients was treated with excision and the other by repetition of the same method with no further complaints. Silver nitrate application for Bartholin cysts or abscesses was found to be an effective, simple, inexpensive and the least anaesthetic requiring procedure, which can easily be carried out in the outpatient setting.