Dear Editor,

We read with great interest, the article titled “Evaluation of treatments for Bartholin’s cyst or abscess: A systematic review” by authors BJG Illingworth K Stocking M Showell E Kirk JMN Duffy Published in BJOG volume 127, issue 6, May 2020. The article was particularly relevant owing to the fact that Bartholin’s Abscess is a common gynaecological presentation which we encounter regularly in clinical practice.

Whilst this article provided some insight into the various techniques for managing Bartholin’s Abscess around the world[1] , there were a few points that we would like to raise. It was not unexpected that the meta-analysis finally concluded that no single technique was superior to the others. This may very well have been due to the different criteria used by these studies to assess the effectiveness of the procedure. Since the failure or success of any technique is largely based on the effect on the quality of life and perception of the outcome by the patient, it may have been more prudent to compare different surgical interventions in terms of patient acceptance, overall satisfaction and long term outcome. Also this analysis compiled data from countries where health services are provided by the private and /or the government sector where the financial incentives for performing procedures vary widely [1] . The article does not elaborate on the proportion of patients who had received pharmacological treatment for varying durations prior to these surgical interventions, which undoubtedly may have influenced the outcome[1]. The analysis also does not include any study where marsupialization was performed under local anaesthetic which may be equally if not more effective than the word catheter at equal cost. In the light of current pandemic situation that the whole world is facing, expertise into minimally more invasive gynaecological procedures to be performed in office setting would also be a key point of consideration. We look forward to the authors comments on these factors.

Piyushi Sharma,¹ Thangamma Katimada-Annaiah,¹ Montasser Mahran,¹ Dilip Patil,¹ Elvyna Lim,¹ Joseph Nattey,¹ Tarley Davies¹

Bedford Hospital NHS Trust

References

1. Illingworth BJG, Stocking K, Showell M, Kirk E, Duffy JMN. Evaluation of treatments for Batholin’s Cyst or abscess: A systematic Review. BJOG 2020;127:671-678