Treatment of Bartholin's abscess

Andersen, Per Grünwald; Christensen, Steen Bach; Detlefsen, G. U.; Kern-Hansen, P.

doi:10.3109/00016349209007949

Cited by 23 publications

(2 citation statements)

References 9 publications

(6 reference statements)

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“…A main issue in the treatment of the cyst or abscess of Bartholin is the recurrence rate. Previous authors have compared different treatments of a cyst or abscess of the Bartholin gland in two systematic reviews reporting on nine case series ( n = 561), one retrospective cohort study ( n = 58), and two small, randomised controlled trials ( n = 32 and n = 38) . Recurrence rates varied between 0 and 13% for marsupialisation and between 3 and 17% for Word catheter.…”

Section: Introductionmentioning

confidence: 99%

Word catheter and marsupialisation in women with a cyst or abscess of the Bartholin gland (WoMan‐trial): a randomised clinical trial

Kroese

Velde

Morssink

et al. 2016

BJOG

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This randomised controlled trial (RCT) by Kroese et al. tackles an interesting, common gynaecological condition of significant clinical importance. It is original work as the previous RCTs (Ander-sen et al. Acta Obstet Gynecol Scand 1992;71:59-62; Gennis et al. Am J Emerg Med 2005;23:414-15) were small, and not as well designed. When appropriately designed, conducted and reported, RCTs represent the reference standard in evaluating healthcare interventions. This RCT demonstrated that in women with an abscess or cyst of the Bartholin gland, treatment with Word catheter or marsu-pialisation resulted in comparable recurrence rates. Median time from ran-domisation to treatment was 3 hours shorter for Word catheter than for mar-supialisation. Maximal and average pain experienced during treatment were both higher in the Word catheter group compared with marsupialisation. However, pain scores after treatment were comparable , although those women undergoing marsupialisation required more analgesia during the first postoperative day. There are obviously other confounding factors affecting the recurrence rate, such as diabetes. How did the authors address that issue and was there any trend difference in the diabetic group? In other words, in a woman with diabetes how can the authors reliably make inferences that the recurrence is method/technique-related and not attributed to her dia-betes? This RCT is well designed, conducted and adequately implemented the Consolidated Standards of Reporting Trials recommendations (CONSORT) (Schulz, et al. BMJ 2010;340:c332). One of these recommendations is that the trial's results be discussed in light of the totality of the available evidence. There is explicit reference in the discussion to the results of the systematically conducted , published review of previously reported studies, explaining why the current study was justified. I agree with the authors' statements that the strengths of this RCT are the following. 1. The multicentre design within 19 hospitals reflects daily practice, and allows generalisation of the results. 2. A robust follow up, exclusion criteria and follow-up strategy have been conducted. However, I am not sure why women under 18 years were excluded, not under 16 years for instance. I wonder whether the latter would have expedited the recruitment and shortened the duration of the study (2010-14)? 3. The sample size calculation meant that the RCT is adequately powered to result in meaningful conclusions. 4. Statistical analysis was performed according to the intention-to-treat principle. This RCT also adapts the proposal by Docherty et al. (BMJ 1999; 318:1224-5) stating the main results, the strengths and limitations, interpretation/ comparison with the previous reviews/ RCTs and literature, but could have elaborated further on implication on clinical practice. The authors stated that 'In our opinion, our data therefore favour treatment of a Bartholin cyst or abscess with a Word catheter since this is the fastest procedure, relieving pain sooner after diagnosis,...

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Section: Introductionmentioning

confidence: 99%

Word catheter and marsupialisation in women with a cyst or abscess of the Bartholin gland (WoMan‐trial): a randomised clinical trial

Kroese

Velde

Morssink

et al. 2016

BJOG

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“…La marsupialisation a l'inconvénient d'exposer davantage aux douleurs cicatricielles [12,20,21] ; • d'autres techniques ont été décrites : mise en place d'un cathéter de Word (ballonnet gonflable introduit après incision et laissé en place pendant un mois), application intracavitaire de nitrate d'argent, fenestration large de la paroi de l'abcès, vaporisation au laser CO 2 , curetage intracavitaire. Toutes ces méthodes, illustrées par de petites séries dans la littérature, ne sont pas validées pour la pratique quotidienne [22][23][24][25][26] ; • dans tous les cas, il conviendra d'effondrer les logettes intracavitaires pour éviter tout cloisonnement, de réaliser un prélèvement bactériologique, et un lavage antiseptique abondant. Nous insistons également sur l'importance d'une couverture antibiotique peropératoire couvrant les germes du tractus digestif et que n'ont pas reçue les patientes de nos observations.…”

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