CHAPTER 131 Bartholin’s Cyst and Abscess
Word Catheter Insertion, Marsupialization
Bartholin’s glands are located at the vaginal opening between the hymenal ring and labia minora (at approximately the 5 and 7 o’clock positions). Simple incision and drainage (I&D) of a Bartholin’s duct cyst or gland abscess may give immediate results with significant pain relief, but recurrence after such a procedure is common. Bartholin’s cysts and abscesses are best treated using a Word catheter to induce the formation of an epithelialized tract from the vulvar vestibule to the cyst. This allows continued functioning of the Bartholin’s gland, proper drainage, and minimal recurrence. The recurrence rate using this technique is between 2% and 15%. The Word catheter has a short latex stem with an inflatable bulb at the distal end (Fig. 131-1) and can be used for both conditions.
For patients with noninflamed and recurrent Bartholin’s cysts, marsupialization is a permanent cure. The procedure can be performed in the office but often is done as a same-day surgical procedure. It is very well tolerated by patients, with a rapid healing time and minimal postprocedure discomfort. Complications are rare and the technique is easily learned, especially by those physicians familiar with perineal repairs.
Figure 131-2 Insertion of Word catheter. A, Bartholin cyst after local anesthetic has been injected superficially. B, No. 11 blade points to ideal location inside the hymenal ring for the incision. However, the cyst is more prominent externally, so incision will be made there. C, Incising the cyst. Make the opening just large enough for the uninflated Word catheter tip to enter. D, Slide Adson forceps with teeth along the blade (which is in the cyst/abscess) and gently grasp the tissue. This will define the tract into the cyst. If this is not done, especially in smaller cysts, a false cavity may be created when inserting the catheter. E, The blade is removed but the forceps are kept in place. Insert the catheter along the forceps. F, Remove the forceps. Inflate the balloon with saline. Gently tug the catheter after inflation to ensure it does not fall out of the opening. G, Balloon is inflated within the cavity of the cyst so that it will not fall out through the stab wound. H, Tuck the exposed portion of the catheter into the vagina. I, Appearance of the area immediately after removal of the catheter.