Bartholin’s Marsupialization

Chapter 23 Bartholin’s Marsupialization



Common indications


Marsupialization of the Bartholin’s gland is commonly performed for recurrent infections of the gland or failure of a Word catheter to adequately treat the problem. Word catheter placement is the first-line therapy for an infected Bartholin’s gland. If infections recur or if Word catheter placement is not curative, then marsupialization of the gland is the most definitive therapy. Marsupialization can be done in the clinic setting or in same day surgery, depending on the patient’s preference for anesthesia (Figure 23-1).


image

FIGURE 23-1 Anatomy.



Equipment


The equipment required for marsupialization includes 10 cc of a lidocaine and bupivacaine local anesthetic 1:1 mixture with a long 27-gauge needle for injection, a minor surgery tray with a No. 15 blade scalpel, and 3-O absorbable braided suture such as Vicryl or Dexon (Figure 23-2).


image

FIGURE 23-2 Equipment.



Key steps



1. Preparation and anesthesia: Place the patient in the lithotomy position, and cleanse the perineum with antiseptic solution. Palpate the cyst to clearly visualize its size and location. Place a block over a 2-cm diameter area on the vaginal sidewall that overlies the surface of the cyst. If local cellulitis and induration are present, a field block may provide optimal anesthesia.

2. Incision: Outline the incision using a surgical marker just deep to the junction of the vaginal sidewall and labia minora. The incision should be a 2- to 3-cm ellipse whose long axis follows the internal axis of the vaginal sidewall, not involving the external labial skin. Use the No. 15 blade scalpel to create the elliptical incision. The vaginal mucosa is entered, followed by a careful incision through the fascia overlying the cyst. There are several layers of fascia and vaginal wall smooth muscles that will be divided in this process. These layers are opened sharply until the cyst wall is entered and begins to drain. When the cyst is entered and drained, the ellipse of tissue is fully excised, effectively removing the roof of the cyst that has been adjacent to the vaginal sidewall. What remains is the smooth cyst cavity with its distinct edge that must be clearly identified before closure begins (Figure 23-3A, B).

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Dec 12, 2016 | Posted by in GENERAL & FAMILY MEDICINE | Comments Off on Bartholin’s Marsupialization

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