Treatment of ganglions; a five year experience

To evaluate and determine the effectiveness of surgical excision, aspiration and injection in the treatment of symptomatic ganglions.

The prospective randomized control trial based on non-probability convenience sampling was conducted at the Department of Surgery, Combined Military Hospital, Sialkot, from June 2007 to August 2010, and at the Department of Surgery, Islam Teaching Hospital, Sialkot, from September 2010 to December 2012. The last patient was included in June 2012. Adult patients referred by general practitioners with ganglia of wrist, ankle and knee were included. All the patients were offered treatment options of intralesional steroid injection or excision of ganglion.The study population was distributed in two groups: Group I opted for aspiration and injection treatment, while Group II went for surgical treatment. A minimum follow-up of six months was mandatory for inclusion in the study. Data was compared and analyzed using SPSS version 22.

The study had 173 patients with 187 ganglia. Group I had 143(76.4%) patients, while Group II had 44(23.3%). In the short term, 82(57.3%) of the patients achieved complete resolution after one episode of aspiration and injection, and success rate after second injection repeated after 3 weeks was 116(81%). Overall success rate of aspiration and injection of Triamcinolone acetonide six months after the treatment was 116(81%). On the surgical side the success rate was 41(93%). Complications like pain, joint stiffness and ugly scar were few and not significant. Comparison of failure rates of the two groups (19% vs 7%) showed significant difference (p<0.028).

In symptomatic ganglia, surgical excision was a better treatment option as the failure rate was less compared to injection-aspiration. The injection treatment should be offered to those who are not willing for surgery, but they should be properly counselled about the chances of failure.