A woman presents with a fluctuant non tender swelling at the introitus. The best treatment is:
The diagnosis in the question points towards the diagnosis of Baholin's cyst. Though both surgical resection and marsupialisation are used in the surgical management, the latter is preferred more due to its advantages. Incision and drainage would be appropriate for Baholin's abscess. Aspiration would lead to recurrence and thus not used in the surgical management of Baholin's cyst. The advantages of marsupialisation over surgical resection: The procedure is simple and can be done as a out patient procedure Even local anesthesia would be sufficient Requires only a sho hospital stay as within 24 hours Postoperative complications is very much less as there are increased chances of bleeding with surgical resection Better cosmetic outcome The gland secretion is maintained intact Ref: Dutta Gynaecology 2nd edition page 148, 4th edition, Page 152; Shaw's Textbook of Gynaecology; 13th edition, Pages 196-97; Atlas of Gynecologic Surgery by By Hans A. Hirsch, Otto Kaser, Franz Anton Ikle; 3rd edition, Page 129; Family Practice Guidelines By Jill C. Cash, Cheryl A. Glass; 2nd edition, Pages 322-33
Marsupialisation
Incision and drainage
Surgical resection
Aspiration