Bartholin’s Gland Marsupialization

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Chapter 230 Bartholin’s Gland Marsupialization

DESCRIPTION

Marsupialization is drainage and permanent fistulization of symptomatic cystic dilation of the Bartholin gland. This provides an alternative to the obstructed anatomic drainage of the Bartholin gland.

INDICATIONS

Symptomatic cystic dilation of the Bartholin gland. Asymptomatic cysts in women younger than age 40 do not need treatment. (In patients older than age 40, biopsy is indicated.) When performed for recurrent abscess formation, marsupialization should be deferred until inflammation has subsided.

CONTRAINDICATIONS

Incomplete evaluation of the vulvar lesion, bleeding diathesis, active inflammation or infection, age >40 years, known or suspected allergy to agents used (e.g., latex, iodine).

REQUIRED EQUIPMENT

• Skin preparation materials (alcohol, iodine- or hexachlorophene-based antibacterial solution [e.g., Betadine, Hibiclens])
• Sterile gloves
• 1% lidocaine without epinephrine, 5-cc syringe, 22-gauge needle
• Scalpel (#11 or #15 blade)
• 3-0 or 4-0 absorbable suture on a small cutting needle, needle holder, thumb forceps, suture scissors
• Electrosurgical generator, hand piece, and return electrode (“ground pad”)
• Sterile gauze pads (2″ × 2″ or 4″ × 4″)
• Word catheter or iodoform gauze packing (1/4″ or 1/2″)

TECHNIQUE

After appropriate informed consent has been obtained from the patient, the skin of the vulva is disinfected. When a regional or general anesthetic is not used, local anesthesia using local or field infiltration is appropriate. The cyst should be stabilized and tensed by gentle finger pressure applied on either side of the affected labium, below the cyst. An incision should be made over the body of the cyst and within the hymeneal ring (generally near the 4- to 5-o’clock or 7- to 8-o’clock positions of the introitus). The incision is generally made in a cruciate manner and extended for up to 2 to 3 cm in longest axis (based on the size of the cyst). Hemostasis should be obtained using electrosurgical energy. Many prefer to sew the edges of the incision open by tacking the center of the flaps outward in a petal-shaped manner. As an alternative, the incision may be made using electrosurgical energy, taking advantage of the tendency for the resultant slough of skin edges to produce a fistula track. A Word catheter or iodoform gauze packing should be placed after final hemostasis has been achieved.

COMPLICATIONS

Bleeding, hematoma, recurrence.

FOLLOW-UP

Word catheters should be left in place for 4 to 6 weeks. Iodoform gauze packing should be gradually removed over the course of several days. Recurrence is frequent (5% to 10% of cases).

CPT CODE(S)

56440 Marsupialization of Bartholin gland

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REFERENCES

Level II

Eilber KS, Raz S. Benign cystic lesions of the vagina: a literature review. J Urol. 2003;170:717.

Level III

Cheetham DR. Bartholin’s cyst: marsupialization or aspiration? Am J Obstet Gynecol. 1985;152:569.

Eckert LO, Lentz GM. Infections of the lower genital tract. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, editors. Comprehensive Gynecology. 5th ed. Philadelphia: Mosby/Elsevier; 2007:572.

Hill DA, Lense JJ. Office management of Bartholin gland cysts and abscesses. Am Fam Physician. 1998;57:1611. 1619.

Omole F, Simmons BJ, Hacker Y. Management of Bartholin’s duct cyst and gland abscess. Am Fam Physician. 2003;68:135.

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Chapter 230 Bartholin’s Gland Marsupialization

DESCRIPTION

Marsupialization is drainage and permanent fistulization of symptomatic cystic dilation of the Bartholin gland. This provides an alternative to the obstructed anatomic drainage of the Bartholin gland.

INDICATIONS

Symptomatic cystic dilation of the Bartholin gland. Asymptomatic cysts in women younger than age 40 do not need treatment. (In patients older than age 40, biopsy is indicated.) When performed for recurrent abscess formation, marsupialization should be deferred until inflammation has subsided.

CONTRAINDICATIONS

Incomplete evaluation of the vulvar lesion, bleeding diathesis, active inflammation or infection, age >40 years, known or suspected allergy to agents used (e.g., latex, iodine).

REQUIRED EQUIPMENT

• Skin preparation materials (alcohol, iodine- or hexachlorophene-based antibacterial solution [e.g., Betadine, Hibiclens])
• Sterile gloves
• 1% lidocaine without epinephrine, 5-cc syringe, 22-gauge needle
• Scalpel (#11 or #15 blade)
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