If a cyst develops in one of Bartholin's glands, don't try to excise it completely; marsupialize it instead, which means bringing its wall to the surface as a pouch, which will slowly heal. This is easier than trying to excise it, which is more difficult for routine use under the conditions in which we work. Also marsupialize an abscess; this is less easy, because its wall is soft and poorly defined. If necessary, merely incise it and marsupialize it later when it is not infected.
Fig. 20-2 MARSUPIALIZING A BARTHOLIN'S CYST. A, the cyst. B, the incision with its extensions. C, opening out the cyst. D, the first sutures. E, sutures almost complete.
BARTHOLIN'S CYST AND ABSCESS Marsupialization can sometimes be an outpatient operation.
ANAESTHESIA. Give the patient a general anaesthetic, or use ketamine, or subarachnoid or epidural anaesthesia.
MARSUPIALIZING A CYST. Ask your assistant to immobilize the cyst with sponges on forceps. Make a longitudinal incision, with extensions at either end, in the margin between her vulval mucosa and her skin, on the inside of her labium minus. Let the fluid escape. Apply Allis' forceps on the edges of her labium minus, and retract them laterally. If necessary, push the cyst forwards by putting a finger behind it. Use interrupted catgut sutures to tie the edges of the cyst wall to her skin, and to stop bleeding.
MARSUPIALIZING AN ABSCESS is a painful minor emergency, which is easier before the abscess ruptures, so operate soon. Excise an ellipse of skin over the abscess, to include the duct, and suture the cyst wall to her skin. Give her antibiotics (ampicillin or tetracycline), advise several salt baths daily, and give her an analgesic.
CAUTION ! Don't try to excise a cyst unless it has recurred after marsupialization. If so, admit her; excision is often complicated by heavy bleeding and haematoma formation.