Marsupialization

Overview

Marsupialization is a surgical procedure utilized for the treatment of Bartholin cysts, which develop when blockage arises at the opening of the Bartholin glands, leading to fluid accumulation and the formation of a lump near the vaginal opening. During the procedure, a slit is made into the cyst to facilitate drainage, followed by suturing the cyst’s edges to the surrounding tissue to create a small pouch. This pouch enables the unrestricted drainage of fluid from the Bartholin gland, promoting healing and alleviating symptoms.

Reasons for undergoing the procedure

Marsupialization might be considered when a cyst persists despite less invasive interventions, although not all Bartholin cysts necessitate treatment. Typically, marsupialization is not the initial recommendation from your doctor.

Your doctor may suggest marsupialization if:

• You have a history of Bartholin gland cysts recurring after treatment.
• Conservative approaches, such as using a Word catheter, have not successfully resolved the cyst.
• The cyst has reached a size where it hinders sitting, walking, or engaging in sexual intercourse.
• You develop cysts that become infected and form abscesses, leading to pain and fever.
• Your cyst causes significant pain or discomfort.

Both Word catheters and marsupialization exhibit similar success rates. In the case of a Word catheter, your provider inserts it into the cyst, creating a passage for fluid drainage. Given its less invasive and more cost-effective nature, a Word catheter is usually the initial recommendation.

If the cyst recurs after a Word catheter and marsupialization, your doctor may propose the removal of your Bartholin gland (excision). Excision is a last-resort option due to increased surgical risks, such as potential excessive bleeding.

Before the procedure

Before proceeding with the procedure, your doctor will provide a detailed explanation and obtain your consent. This will involve:

• Reviewing your medical history to confirm your suitability for marsupialization.
• Discussing any risk factors or potential complications.
• Offering guidance on preparation for the procedure and planning for your recovery.

For instance, depending on the anesthesia chosen by your doctor, you might need to arrange for someone to drive you home afterward. Additionally, you may need to request time off from work to ensure you have sufficient time for recovery.

During the procedure

Marsupialization typically has a duration of 10 to 15 minutes and commonly occurs in an operating room. It is usually an outpatient procedure, allowing you to return home on the same day. Throughout the procedure, your doctor will:

• Position you in a dorsal lithotomy stance on a table, lying on your back with your legs bent at 90 degrees and supported by padded footrests.
• Administer anesthesia to ensure you don’t experience pain. Marsupialization can be conducted under local anesthesia (numbing the area near the surgery site while you’re awake) or general anesthesia (keeping you asleep throughout the procedure).
• Cleanse the surgical site, including the perineum (the area between your vaginal opening and anus), to minimize the risk of infection.
• Make an incision along the length of the cyst, drain it, and irrigate the opened cyst cavity with saline.
• Fold the tissue of the exposed cyst backward and suture it to the adjacent skin on your vulva. These sutures will dissolve over time, creating a small open pouch that is continuous with the surrounding skin, allowing continuous drainage from the Bartholin gland.
• If necessary, inspect the cyst walls for any tissue exhibiting signs of cancer. A biopsy may be performed to test the tissue for the presence of cancer cells.

Bartholin cyst cancer is exceedingly rare, accounting for only 5% of vulva cancers, and the risk is higher for individuals aged 40 and above.

After the procedure

Following marsupialization, your cyst transforms from a fluid-filled sac into a small pouch, approximately a quarter of an inch in size.

Your provider will carefully examine your wound to ensure there is no excessive bleeding. They may opt to lightly pack your wound with gauze, though typically, using a sanitary pad to manage any blood discharge from the wound is sufficient.

You may spend a few hours in a recovery room before being discharged to go home. Prior to your release, your doctor may prescribe pain medications for severe pain or recommend over-the-counter options. While antibiotics might be prescribed to prevent infection, they are often unnecessary after marsupialization.

A follow-up appointment is usually scheduled for one week after the surgery.

Risks

Similar to any surgical procedure, marsupialization carries some inherent risks, although complications are infrequent. These complications may include:

• Pain.
• Infection.
• Scarring.
• Hematoma (accumulation of blood at the surgical site).
• Pain during intercourse (dyspareunia).

Outcome

Allocate two to four weeks for your wound to fully heal, adhering to your doctor’s guidance on cleaning and tending to the wound. Anticipate the following timeline:

• For the next day or two: You may experience discomfort and pain at the wound site, but this should gradually improve.
• For the next three to five days: Consider taking one or more sitz baths daily to soothe the wound and facilitate healing.
• For the next two weeks: You might observe slight bleeding or vaginal discharge. Managing this with a panty liner should suffice. Fatigue may set in easily, necessitating regular pain medication.

To enhance the healing process during recovery, consider:

• Adhering to prescribed medications.
• Opting for loose, comfortable underwear or jeans.
• Maintaining a nutritious diet and staying adequately hydrated.
• Ensuring ample rest and avoiding excessive exertion.