OB-GYN Journal article
Surgical Treatment of Bartholin’s Gland Abscess: Is Word Catheter Superior to Marsupialization?
Reut Rotem, Chagit Diamant, Misgav Rottenstreich, Maggie Goldgof, Moshe Barg, Noa Greenberg, Boaz Sheizaf, Adi Y. Weintraub, Surgical Treatment of Bartholin’s Gland Abscess: Is Word Catheter Superior to Marsupialization?, Journal of Minimally Invasive Gynecology, Volume 28, Issue 6, 2021, Pages 1211-1215
I chose to write my journal article based on my first H&P on the patient with a Bartholin’s cyst. I thought this case was interesting as I never was familiar with the multiple management techniques, such as I&D, marsupialization, or word catheterization. The provider I was working with told the patient that for her using a word catheter would be the best option, but I wanted to do more research on the other treatment modalities.
Bartholin’s glands are located on the posterior aspect of the labia minora and become active during puberty and secrete mucus to lubricate the vagina. Obstructions in this gland can cause the secretions to accumulate and form an inflamed cyst. Often times these cysts are quite painful and need drainage along with antibiotics when systemic symptoms present. This drainage is usually done by either using a word catheter or by marsupialization.
The Word catheter is a catheter with a balloon at its end, that gets inflated after being inserted into the abscess after drainage. It is left there for several days and allows for continuous drainage of the abscess, and allows for re-epithelialization. This is usually done at bedside or in an outpatient setting. The risks include increased chances of recurrence if the catheter is expelled early. Marsupilaizatin is usually performed in the OR and is a longer more complex procedure. In this the cyst is drained and the edges are sutured together to make a permeant exit for the abscess to drain. Possible adverse effects include the formation of a hematoma, infection, scarring and dyspareunia. However this is a ore permanent solution and there are less chances of recurrence.
This study is a retrospective cohort study in which 321 women were managed surgically using either a word catheter or by using incision and marsupialization. Women between the age of 18-90 who have had a Bartholin’s cyst were included. During the study, both groups had uniform preop and post op care. They had follow up 2-3 weeks post procedure in an outpatient clinic. The primary outcome was the comparison of abscess recurrence between the 2 modes of management. Other factors such as fever, side of abscess, test results, need for antibiotics was also collected. No difference was found in the recurrence rates of both of these procedures. Also there was no difference in post procedure pain, bleeding or infection. There was no difference n the overall result, however the word catheter may be a more popular option, as it is “minimally invasive” and there is no need for the patient to go to the OR. Both procedures have pros and cons, but they both have very successful outcomes, so it depends on the patient’s preference.
