Bartholins gland cyst

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.

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.

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.