Prospective Randomized Study of Marsupialization versus Silver Nitrate Application in the Management of Bartholin Gland Cysts and Abscesses

Abstract

Study Objective To prospectively compare the efficacy of marsupialization or silver nitrate application in the treatment of Bartholin gland cysts abscesses, both of which are widely used as outpatient procedures. Design Prospective randomized trial. Design classification I. Setting Teaching and research hospital, a tertiary center. Patients A total of 212 patients admitted to our gynecology clinic with symptomatic Bartholin gland cysts/abscesses. Interventions Marsupialization and silver nitrate application in Bartholin gland cysts/abscesses. Measurements and Main Results In all, the 212 patients were randomly allocated to either marsupialization (group I) or silver nitrate application (group II) from March 2005 through March 2007. A total of 159 women were eligible for reevaluation at the end of the sixth month. In all, 83 were randomized to group I and 76 to group II. The patients were called for revisits at day 3, day 7, month 1, and month 6 of treatment. The 2 groups were compared for recurrence rates as primary outcome and duration of procedures, complications, size of scar tissues, and presence of dyspareunia as secondary outcomes. Comparisons of 2 groups were evaluated by Pearson χ 2 test and Mann-Whitney U test, as appropriate. The 2 groups were comparable with regard to age, parity, and diameter of cyst or abscess. The recurrence rates were similar: 24.1% in group I and 26.3% in group II at 6 months (p =.67). No statistically significant differences were found in respect to duration of procedures or presence of dyspareunia. Complete healing without scar formation was observed in 31.3% and 55.7% of patients in groups I and II, respectively, and this was statistically significant (p =.007). Conclusion Marsupialization and silver nitrate application seem to be equally effective management methods in Bartholin cyst and abscesses, however, silver nitrate favors complete healing with less scar formation.