Bartholin Cyst Treatment
For Bartholin duct cysts and gland abscesses larger than 2 cm, drainage with Word catheter placement or marsupialization is recommended, as simple incision and drainage leads to high recurrence rates. 1, 2
Initial Assessment and Management Strategy
Asymptomatic or Small Cysts (<2 cm)
- Expectant management is appropriate for asymptomatic Bartholin duct cysts, as many resolve spontaneously without intervention 1
- No surgical intervention is needed unless the cyst becomes symptomatic or infected 1
Symptomatic Cysts or Abscesses (≥2 cm)
- Active drainage is required because infected cysts or abscesses larger than 2 cm do not resolve spontaneously and tend to recur 1
- Simple incision and drainage should be avoided as it results in high recurrence rates 2
Recommended Surgical Approaches (in order of preference)
First-Line: Word Catheter Placement
- Word catheter is the most frequently employed technique for office and emergency department management 3, 2
- The catheter remains in place to allow epithelialization of a drainage tract 3
- Common pitfall: The catheter has a tendency to dislodge before complete epithelialization, leading to recurrence 3
- Alternative technique using a secured loop of plastic tubing can prevent premature expulsion 3
Second-Line: Marsupialization
- Marsupialization is highly effective and can be performed in the office setting 2
- This involves creating a permanent opening by suturing the cyst wall edges to the surrounding skin 4
- The "window operation" variant involves excising a small oval piece of skin including the cyst wall and suturing along the excised margin under local anesthesia 4
- A new mucocutaneous junction forms by 4 weeks postoperatively 4
Additional Treatment Options
- Silver nitrate application can be used for cyst ablation 5
- Carbon dioxide laser cauterization is another alternative 5
- Surgical excision is reserved for recurrent cases or when malignancy is suspected 5
Antibiotic Therapy
- Oral antibiotics should be prescribed for acute inflammation or abscess formation 4
- Antibiotics are given postoperatively in cases with acute inflammation 4
Follow-Up
- 4-week postoperative checkup is recommended to assess healing and formation of new mucocutaneous junction 4
- Monitor for complications or recurrence during follow-up visits 4
Critical Pitfalls to Avoid
- Never perform simple incision and drainage alone, as this leads to high recurrence rates 2
- Ensure Word catheter or drainage device remains in place long enough for complete epithelialization 3
- Rule out malignancy in recurrent or atypical cases, particularly in women over 40 years of age 5