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Management of Bartholin Duct Cysts and Abscesses: A Systematic Review

Wechter, Mary Ellen MD, MPH*; Wu, Jennifer M. MD, MPH; Marzano, David MD; Haefner, Hope MD§¶

Obstetrical & Gynecological Survey: June 2009 - Volume 64 - Issue 6 - p 395-404
doi: 10.1097/OGX.0b013e31819f9c76
CME Program: Category 1 CME Review Articles 16, 17, and 18: CME Review Article 16
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Objective. To review systematically the literature, published in English, on recurrence and healing after treatment of Bartholin duct cysts and abscesses.

Data Sources. We searched PubMed, EMBASE, CINAHL, LILACS, Web-of-science, the Cochrane database, and POPLINE from 1982 until May 2008. We searched the internet, hand-searched reference lists, and contacted experts and authors of relevant papers to detect all published and unpublished studies.

Methods of Study Selection. We included any study with at least 10 participants, addressing either frequency of recurrence or healing time after treatment of Bartholin duct cyst or abscess. We followed MOOSE (meta-analysis of observational studies in epidemiology) guidelines. Of 532 articles identified, 24 studies (5 controlled trials, 2 cohort studies, and 17 case series) met all inclusion criteria. Study size ranged between 14 and 200 patients.

Tabulation, Integration, and Results. The interventions included: (1) Silver nitrate gland ablation, (2) cyst or abscess fenestration, ablation, or excision using carbon dioxide (CO2) laser, (3) marsupialization, (4) needle aspiration with or without alcohol sclerotherapy, (5) fistulization using a Word catheter, Foley catheter, or Jacobi ring, (6) gland excision, and (7) incision and drainage followed by primary suture closure. The reported frequency of recurrence varied from 0% to 38%. There was no recurrence after marsupialization in available studies. Recurrence after other treatments varied, and was most common after aspiration alone. Healing generally occurred in 2 weeks or less.

Conclusion. There are multiple treatments for Bartholin duct cysts and abscesses. A review of the literature failed to identify a best treatment approach.

Target Audience: Obstetricians & Gynecologists, Family Physicians

Learning Objectives: After completion of this article, the reader should be able to identify seven different treatments for Bartholin duct cysts or abscesses, contrast treatment choice complications and recurrence risks for the different options for treatment of Bartholin duct cysts or abscesses, and point out the limited quality and quantity of data upon which to choose best practices.

*Senior Associate Consultant, Department of Gynecology, Mayo Clinic Florida, Jacksonville, Florida; †Assistant Professor, Department of Obstetrics and Gynecology, Division of Urology, Duke Medical Center, Durham, North Carolina; and ‡Clinical Instructor, §Professor, Department of Obstetrics and Gynecology, ¶Co-director of the University of Michigan Center for Vulvar Disease, University of Michigan Health System, Ann Arbor, Michigan

Chief Editor’s Note: This article is part of a series of continuing education activities in this Journal through which a total of 36 AMA/PRA Category 1 Credits™ can be earned in 2009. Instructions for how CME credits can be earned appear on the last page of the Table of Contents.

Dr. Wu has disclosed that she was a recipient of a grant from ACOG/Wyeth and she was/is the recipient of a grant from Pfizer. All other authors have disclosed that they have no financial relationships with or interests in any commercial companies pertaining to this educational activity.

The Faculty and Staff in a position to control the content of this CME activity have disclosed that they have no financial relationships with, or financial interests in, any commercial companies pertaining to this educational activity.

Lippincott Continuing Medical Education Institute, Inc. has identified and resolved all faculty conflicts of interest regarding this educational activity.

Reprint requests to: Mary Ellen Wechter, MD, MPH, 4500 San Pablo Rd., Jacksonville, FL 32224. E-mail: Wechter.Mary@mayo.edu.

© 2009 Lippincott Williams & Wilkins, Inc.