Publication:

Outcomes of surgical excision versus aspiration for wrist ganglion cysts: a comparative cohort study

Background To compare recurrence rates and clinical outcomes after open surgical excision versus needle aspiration in patients with wrist ganglion cysts.

Methods We analyzed 84 consecutive patients treated for wrist ganglion cysts between Jan 2019 and Jan 2023 at a single center. Fifty-three patients underwent open excision of the ganglion, while 31 underwent cyst aspiration plus steroid injection. Patients were followed for 12 months, with assessment of cyst recurrence (by clinical examination and confirmed by ultrasound), pain (visual analog scale) and patient satisfaction. Group comparisons were performed using χ² or t-tests.

Results Demographic variables (age, sex, cyst location) were similar between groups. Recurrence occurred in 11 of 53 excision patients (20.8%) versus 18 of 31 aspiration patients (58.1%) (p<0.001). Surgical excision significantly reduced the risk of recurrence compared with aspiration. Mean pain scores improved in both groups, with a greater reduction after excision (mean VAS reduction 5.6 vs 3.5, p=0.01). Most patients in both groups were satisfied: 94.3% after excision versus 77.4% after aspiration (p=0.045). Complications were few (3.8% overall), occurring only in the excision group (5.7% versus 0%, p=0.46).

Conclusions Open surgical excision of wrist ganglia yields markedly lower recurrence than aspiration, with high patient satisfaction in either group. Aspiration is less invasive but is associated with a significantly higher recurrence rate. Open excision should be preferred for durable cure, although aspiration may still be considered for selected patients.