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Objective: To demonstrate the long-term outcome of a symptom-solving treatment model (SSTM). Design: Observational study between June 2016 and December 2022. Setting: Purohit General Hospital Population: 68 consecutive candidates of hysterectomy for severe pelvic endometriosis. Methods: Candidates were treated by the SSTM, which constitutes a systematic vagino-laparoscopic conservative strategy of hysterectomy with preservation of the ovary or ovaries followed by 24 months of postoperative depot-medroxyprogesterone acetate (DMPA) therapy. Cases were followed up to December 2022, 2.5 years beyond the last hysterectomy in May 2020. Main outcome measures: Relief of endometriosis-associated symptoms and prevention of recurrence in the long term. Results: Symptomatic relief of endometriosis-related pain, such as cyclical dysmenorrhoea, pelvic pain, dyschezia, and vaginal pain, occurred in all 68 (100%) cases from the next expected date of menstruation. None of the cases showed a recurrence of endometriosis-related pelvic pain; overall, 37 (54.41%) cases crossed 4–6 years, and 31 (45.58%) cases crossed 2.5–4.0 years following the hysterectomy operation. Four (5.88%) cases had non-endometriotic pelvic pain. None of the cases required repeat surgery or had any major side effects or complications due to DMPA. No major perioperative complications were observed. The results were achieved without the requirement of challenging extensive retroperitoneal laparoscopic dissection, ureterolysis, and rectum surgeries. Conclusions: This SSTM can be an option in indicated cases of severe pelvic endometriosis to provide symptom relief and prevent the recurrence of endometriosis-associated pelvic pain in the long term.

Aim: Recurrence of Bartholin's cyst after various surgical treatments causes an unpleasant situation for the patient and the couple. To prevent recurrence, the present study described an operative procedure to excise the Bartholin's gland cyst or abscess using hydrodissection and bipolar forceps hemostasis. Patients and methods: In a retrospective study in our private hospital, we studied cases that had undergone excision of Bartholin's gland cyst or abscess for benign indications by the described procedures. Results: A total of 21 cases underwent excision of Bartholin's gland cyst or abscess by the described procedures. All were in the reproductive age ranged between 22 and 40 years. Seven of the total 21 cases had history of previous emergency incision and drainage to provide relief of severe vulval pain owing to Bartholin's abscess. All these seven cases had recurrence of Bartholin's cyst subsequently and had to undergo excision of the gland. Of the total 21 cases, 14 had an elective excision of Bartholin's cyst or abscess owing to vulvar swelling and dyspareunia and did not experience recurrence subsequently. None of the 21 cases developed postoperative hematoma, cellulitis, or abscess of the operation site requiring readmission. None of them had bad scarring or had subsequent dyspareunia following the operation. Median operation time was 17 min (13-23 min). None of the total 21 cases that underwent excision of Bartholin's cyst had recurrence of cyst or abscess. Conclusion: Hydrodissection with coagulation hemostasis may simplify successful excision of Bartholin's gland cyst to avoid recurrence.