Drainage, marsupialization and extirpation of Bartholin glands

Article

23. 04. 2018 Gynecology

Bartholin glands are a small pair of glands responsible for the secretion of a liquid that moistens external genitalia as well as the vaginal entrance. Unless the glands are swollen, it is generally not something that can be identified by touch. However, if it enlarges (cyst in the Bartholin gland), it is then detectable by touch. The formation that is identified can vary in size, flexibility but also in the amount of pain that it causes. It is located at the bottom edge of the labia majora. In such cases, it is sometimes necessary to clear the cyst with a surgical procedure. A small incision is then made with a scalpel that allows the liquid to flow freely. To ensure that the cyst does not reappear again, a small plastic tube is inserted in the channel - called a drain. In cases where the cyst reappears, it may be necessary to undergo its complete surgical removal - so called extirpation. 

 

Prior to the procedure

You should receive all important information concerning the planned procedure from your doctor. 

You should however inform your doctor with the following information:

  • You suffer from allergies
  • Any long-term medication you are using
  • Any coagulation disorders you may have (bleeding disorders)
  • Any surgeries you have undergone
  • Any other disease that you are suffering from


Prior to the procedure itself, you can eat dinner. However, from midnight onwards, you should not drink or eat anymore. If you are using long-term medication, ask your doctor if you should take them on the day of the procedure.  

 

During the procedure

The surgical procedure is most commonly carried out under short general anesthesia. During the anesthesia, your veins will be supplied with medication to ensure that you are asleep and relaxed throughout it being carried out. In some cases, the procedure can be carried out using local anesthesia where the anesthetic substance is injected into the skin at the spot where the doctor then carries out the incision. Prior to the procedure, you will be positioned in the so-called gynecology position where you lay down on your back with your feet angled and supported.

Once the affects of anesthesia are fully in place, regardless of whether it was local or general, the doctor disinfects the surgery equipment. A scalpel will then be used to make an incision that will open up the cyst and the resulting opening will allow for its contents to be emptied. If it is puss, a sample is then sent to the laboratory for microbiological examination. A small tube or a plastic stripe is inserted into the cyst cavity (a drain). This remains there for anywhere between 1 to 2 days.  It is then removed and the cavity from the cyst usually closes itself in the following days. If necessary, the doctor can close it using a couple of self-absorbing stitches. 

If the cyst occurs repeatedly, then it is generally necessary to undergo its complete surgical removal (extirpation). 2 techniques are most commonly used to achieve this. The gland is opened with an incision by a scalpel and a chemical substance is introduced for 24-48 hours resulting in the breakdown of the gland. No later than 48 hours later, a repeat surgical examination is carried out to remove the remnants of the cyst. The wound is flushed and usually closed off with a couple self-absorbing stitches. 

The second technique involves the surgical removal of it in one procedure. However in this case, it is more frequently complicated by bleeding not only during the procedure itself but also bruising thereafter.

Marsupialization is used to describe a surgical procedure where the corners of the incision are sutured to the skin temporarily, avoiding any premature closure of the cyst and its subsequent recurrence. 

The procedure typically lasts anywhere from 15 minutes to 1 hour and any overnight hospitalization depends on the individual progress of the surgery.

 

What to ensure following the procedure

  • You should not drive a car for 24 hours after the procedure.
  • For the first 4 days following the procedure, measure your body temperature 2x per day and note down the measurements in case you would need to urgently visit a doctor.
  • Avoid any heavy physical strain for a period of 1-2 weeks following the procedure. For the same amount of time, avoid lifting heavy objects (5 Kg and more).
  • In case a chemical substance is used to remove the cyst, it is necessary for the surgical examination of the wound within 48 hours. In case you are experiencing a stretching/burning/twitching or painful sensation, immediately visit the responsible doctor. 
  • For a period of 2 weeks, only use the shower instead of baths, or accordingly based on the recommendation by the doctor responsible for treating you. For the same time (at minimum), do not swim, use tampons or flush the vagina. 
  • In the first few days following surgery, rinse the would several times each day, ideally with solutions with disinfecting and painkilling qualities (for example an oak bark solution). Keep the wound dry and allow for sufficient amount of fresh air to access the wound (i.e. if you can, do not wear underwear).
  • You can have sexual intercourse between 2-4 weeks following the procedure, considering the wound is fully healed. 

 

Complications

The most common complications of this procedure involve bleeding from the surgical wound as well as the formation of bruises (hematomas) around it. Further complications involve unsuccessful surgery and recurrence of the cyst. Infections can occur in case post-surgical care is neglected.

 

When should you call an emergency?

  • When you suffer from pain that is not getting better even after using painkillers or you experience sudden and escalating pains.
  • When you identify a smelly discharge from the wound or the vagina.
  • When the wound is swollen, painful, red and very warm to the touch. 
  • When you are bleeding from the wound.
  • When you experience a rash.
  • When you experience a fever.
  • When you are experiencing chest pains or have difficulty breathing. 
  • When your head is spinning and you are fainting. 

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