Comment: the quality of evidence is downgraded by study quality (lack of allocation concealment), inconsistency (heterogeneity in patients and co-interventions) and indirectness (recurrence rates much higher than in the normal practice, absence of clear diagnostic criteria for recurrence).
A Cochrane review [Abstract] 1 included 11 studies with a total of 674 subjects. The age of patients varied from 12 years to 79 years. All studies compared needle aspiration to incision and drainage.All but one of the 11 studies reported on the primary outcome of recurrence. When the data from the 10 studies were pooled, the recurrence rate was higher in the needle aspiration group compared with incision and drainage (RR 3.74, 95% CI 1.63 to 8.59; n=612). Three studies reported on adverse events associated with the intervention, one such event was reported (post-procedure bleeding following incision and drainage: 1/28, 3.6%).Time to resumption of normal diet was compared in two studies; neither found an obvious difference between needle aspiration and incision and drainage. In 3 studies, which reported complications of the disease process, the only complication reported was admission to hospital for dehydration in 2 patients who underwent incision and drainage (2/13, 6.7%). The data could not be pooled in a meta-analysis. Two studies evaluating procedural pain reported this to be lower in the needle aspiration groups. One study found comparable rates of pain resolution at 5 days post-intervention between groups.
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