Marsupialization: What does it involve?

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