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.