Marsupialization: What does it involve?

surgeons gloves

By Kanna Ingleson   

Reviewed by Elaine K. Luo, MD
Marsupialization is a surgical
procedure that removes cysts in a way that makes them less likely to return.
Once the cyst has been opened and drained, the edges are sutured together to
form a permanently open “pocket” or “pouch” that allows
fluid to drain easily.
Marsupialization takes about
15 minutes to complete and can be carried out under local or general
anesthetic. After the procedure, the doctor will loosely pack the treated area
with gauze to soak up fluid and to stop bleeding. The doctor will remove the
gauze before the person leaves the hospital.
It usually takes 2 weeks for
the affected area to heal.
Anyone having this surgery
should plan to take the necessary time away from their daily routine and to
abstain from sexual intercourse for about 4 weeks.
Uses
Marsupialization is often used
to treat cysts that form in the Bartholin’s glands. These are a pair of small,
pea-sized glands found just inside the vagina that secrete lubricating fluid
during sexual intercourse.
The fluid travels into the
vagina down tiny tubes called ducts. If these ducts become blocked, they can
fill with fluid and form a cyst.
No one knows for sure why
these ducts get blocked and develop cysts. In rare cases, sexually transmitted
infections may cause Bartholin’s cysts.
Doctors may recommend
marsupialization if a person has a history of recurring Bartholin’s gland
cysts, or if the cysts cause significant pain. It is also a good treatment
option in situations where other treatments have failed.
Marsupialization is an
effective treatment that has few risks. Doctors will not carry out the
procedure if there is an abscess present, however. Sometimes the surgery is
recommended but does not go ahead because the person declines the treatment.
While Bartholin’s gland cysts
are the focus of this article, marsupialization is also used to treat pilonidal
cysts. These cysts occur at the bottom of the tailbone or coccyx. They are more
common in males than females, and many doctors think that ingrown hairs are the
most likely cause.
When to see a doctor about a
cyst


A person should see their
doctor if they have any or all of the following symptoms:

  • a painful, swollen lump
  • no improvement after 3 days of
    home treatment
  • pain is severe enough to
    disrupt daily activity
  • cyst becomes an abscess
  • a fever of more than 38°C
Aftercare

The following courses of
action are recommended to ensure that no complications occur during the
recovery period after surgery:

  • avoiding sexual intercourse
    and using tampons for 4 weeks after surgery
  • keeping the affected area
    clean and dry
  • washing every day with warm
    soapy water
  • wearing cotton underwear and
    avoiding tight clothing
  • taking prescribed medication
    and attending all follow-up appointments
  • eating normally and drinking
    lots of water
  • avoiding strenuous activities
    and getting lots of rest
Complications

Although complications after
marsupialization are rare, they can include the following:

  • infection
  • bleeding
  • pain
  • return of the cyst
During the recovery period, people
should seek emergency treatment if any of the following complications occur:

  • fainting or loss of
    consciousness
  • any trouble breathing
    including shortness of breath
  • chest pain
  • coughing up blood
Alternative treatments

Although marsupialization is a
safe and effective procedure, some people may wish to have a different form of
treatment. The following alternative treatments are available to deal with
Bartholin’s gland cysts:
Needle aspiration
A needle and syringe are used
to suck out the fluid in the cyst. Sometimes, the cavity is filled with an
alcohol solution for a few minutes before being washed out.
Balloon catheter
A type of balloon catheter,
known as a Word catheter, is an alternative to marsupialization for the
drainage and treatment of cysts.
The surgeon makes an incision
in the cyst and inserts the catheter with a balloon at its tip. The doctor then
fills the balloon with up to 4 milliliters (ml) of saline (salt water). Once
the wound starts to heal, the doctor will deflate and remove the balloon,
leaving a permanent drainage passage.
Carbon dioxide laser
Doctors create an opening in
the skin of the affected area using a carbon dioxide laser and drain the cyst.
The cyst is then destroyed with the laser, or left in place with a small hole that
allows any fluid to drain away.
Cauterization
Doctors make a cut in the cyst
and drain the fluid. They then place a piece of silver nitrate into the space
left behind.
Silver nitrate burns the
cavity to form a small lump. After 2 or 3 days, the doctor will remove the
remains of the silver nitrate and cyst remains if they have not already fallen
out.
Self-care
If a cyst is painful, it can
help to soak it in a shallow, warm bath for up to 15 minutes.
For the best results, a person
should do this several times a day for 3 or 4 consecutive days.
A person can also hold a warm
flannel against the affected area and take oral painkillers can at the same
time.
Antibiotics and painkillers
Doctors do not routinely
prescribe antibiotics for Bartholin’s gland cysts. Broad-spectrum antibiotics
are useful if the cyst turns into an abscess or if cellulitis is present.
Antibiotics have not been
shown to prevent the cysts from coming back. People can take painkillers if the
pain is severe.
Gland removal
If cyst recurrence is an
issue, doctors can surgically remove the Bartholin’s duct glands. This surgery
takes place under general anesthetic and takes about an hour.
Doctors may recommend surgery
for people over the age of 40 who have newly developed cysts. The reason for
this is that vulvar cancer can cause lesions in this area, so any new ones
should be examined in the lab. Postmenopausal women are most likely to develop
this form of cancer.
Outlook


Around 1 in every 50 women
will develop a Bartholin’s cyst or abscess. Sexually active women aged between
20 and 30 are most likely to develop them. Not all of these women will require
marsupialization, however.
Marsupialization is an
effective treatment. A systematic review of studies reported no recurrences of
Bartholin’s cysts following marsupialization on 70 people who researchers
followed for 1 month after the procedure.
SOURCE:
MEDICAL NEWS TODAY
Kayode Ojo
Kayode Emmanuel Ojo is the Co-Founder and Managing Director at SHEFFA Limited. He is presently studying Computer Science at the National Open University, Victoria Island, Lagos.