6/7/2014 Bartholin' s Gland Cyst Marsupialization

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Vulva and
Introitus
Biopsy of the Vulva
Excision of Urethral
Caruncle
Bartholin's Gland Cyst
Marsupialization
Excision of Vulvar Skin,
with Split-Thickness
Skin Graft
Bartholin's Gland
Excision
Vaginal Outlet
Stenosis Repair
Closure of Wide Local
Excision of the Vulva
Wide Local Excision
of the Vulva, With
Primary Closure or Z-
plasty Flap
Alcohol Injection
of the Vulva
Cortisone Injection
of the Vulva
Merring Operation
Simple Vulvectomy
Excision of the
Vulva by the Loop
Electrical Excision
Procedure (LEEP)
Excision of
Vestibular Adenitis
Release of Labial
Fusion
Hymenectomy
Excision Of
Hypertrophied Clitoris
Bartholin's Gland Cyst
Marsupialization
Marsupialization of the Bartholin's gland is generally indicated when there is a large abscess that makes surgical
excision of the gland difficult. In this operation, the surgeon opens wide the wall of the abscess and allows the
purulent exudate to drain. The membrane of the abscess is then sutured to the vaginal mucosa and to the skin
of the introitus in order to effect granulation and reepithelialization of the wound from the bottom of the abscess
to the top.
The operation is fast. Hemostasis is not difficult and can be performed under local anesthesia.
The purpose of marsupialization of the Bartholin's gland is to exteriorize the abscess in such a fashion that it will
become epithelialized from the base.
Physiologic Changes. If marsupialization is successful, the epithelium within the gland will be epithelialized with
squamous epithelium.
Points of Caution. The opening into the gland must be sufficient to promote adequate drainage.
Technique
A thorough bimanual examination should be
performed to determine the extent of the abscess.
The labia are retracted with interrupted 3-0 sutures,
and the introitus of the vagina is exposed. An
incision is made over the mucosa of the vagina at its
junction with the introitus down to the wall of the
gland.
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The wall of the gland is incised. The entire length of the superficial incision is shown.
The contents of the abscess are evacuated.
A culture is taken of the abscess. The walls of the
abscess are grasped with Allis clamps.
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The wall of the abscess is sutured with interrupted 3-
0 synthetic absorbable suture to the skin of the
introitus laterally and to the vaginal mucosa medially.
The marsupialization is complete. Generally, no
packing or drain is necessary. The patient is placed
on a regimen of hot sitz baths on the second
postoperative day. A laxative and stool softener are
given on the third postoperative day. Antibiotic
therapy should be directed by the results of the
culture. Sexual intercourse can usually be resumed
in 4 weeks.
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