Abstract
To evaluate the effectiveness, recurrence rate, and complications of carbon-dioxide laser vaporization in the treatment of Bartholin's gland cysts. A retrospective study including 127 patients with symptomatic Bartholin' gland cysts submitted to carbon-dioxide laser vaporization at our institution from January 2005 to June 2011. Patients with Bartholin's gland abscesses and those suspected of having neoplasia were excluded. All procedures were performed in an outpatient setting under local anaesthesia. Clinical records were reviewed for demographic characteristics, anatomic parameters, intraoperative and postoperative complications, and follow-up data. Data were stored and analyzed in Microsoft Excel® 2007 software. A descriptive statistical analysis was performed, and its results were expressed as frequency (percentage) or mean±standard deviation. Complication, recurrence, and cure rates were calculated. The mean age of the patients was 37.3±9.5 years-old (range from 18 to 61 years-old). Seventy percent (n=85) of them were multiparous. The most common symptom was pain and 47.2% (n=60) of patients had a history of previous medical and/or surgical treatment for Bartholin's gland abscesses. Mean cyst size was 2.7±0.9 cm. There were three (2.4%) cases of minor intraoperative bleeding. Overall, there were 17 (13.4%) recurrences within a mean of 14.6 months (range from 1 to 56 months): ten Bartholin's gland abscesses and seven recurrent cysts requiring reintervention. The cure rate after single laser treatment was 86.6%. Among the five patients with recurrent disease that had a second laser procedure, the cure rate was 100%. At this institution, carbon-dioxide laser vaporization seems to be a safe and effective procedure for the treatment of Bartholin's gland cysts.
Highlights
IntroductionThe obstruction of Bartholin’s gland duct as a result of trauma (namely during a mediolateral episiotomy or a posterior colporrhaphy) or of infection leads to cystic enlargement of these glands because of the continued mucus secretion[1,2]
The obstruction of Bartholin’s gland duct as a result of trauma or of infection leads to cystic enlargement of these glands because of the continued mucus secretion[1,2]
Its complications include: haemorrhage, infection of sutures, damage of surrounding structures, cosmetic disfigurement, dyspareunia, and disturbed lubrication of the vagina. It remains the treatment of choice in two specific situations: recurrent cysts refractory to previous techniques and when there is a suspicion of adenocarcinoma of Bartholin’s gland[1,6]
Summary
The obstruction of Bartholin’s gland duct as a result of trauma (namely during a mediolateral episiotomy or a posterior colporrhaphy) or of infection leads to cystic enlargement of these glands because of the continued mucus secretion[1,2]. Its complications include: haemorrhage, infection of sutures, damage of surrounding structures, cosmetic disfigurement, dyspareunia, and disturbed lubrication of the vagina It remains the treatment of choice in two specific situations: recurrent cysts refractory to previous techniques and when there is a suspicion of adenocarcinoma of Bartholin’s gland[1,6]. Marsupialization, first described in 1950 by Jacobson[1], is a surgical alternative to the excision It can be performed under local anaesthesia and has a lower risk of haemorrhage, scarring, postoperative pain and impaired sexual function, once it preserves the secretory function of Bartholin’s glands for lubrication[1,6]. It has been associated with higher recurrence rates (from 2 to 25%)[1]
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