How is Bartholin cyst surgery done? Information on the Word catheter, marsupialisation, gland removal, vaginal cysts, preparation, recovery and recurrence.
Bartholin cyst surgery is the general name for the surgical procedures used to prevent a cyst or abscess of the Bartholin gland at the entrance of the vagina from forming again. The options include drainage with a catheter, marsupialisation and removal of the gland; for some cysts in the wall of the vagina, an excision procedure can also be performed. The method is decided together with your doctor according to the characteristics of the cyst and whether it has recurred before. The information below offers a general framework; it does not replace the individual assessment made for you.
In which situations is a procedure planned?
Most small cysts that cause no pain do not need a procedure. A procedure is considered when the cyst grows and disturbs your daily life or sexual intercourse, when an abscess forms, or when swelling recurs in the same area. The details of the complaints, diagnosis and follow-up are a separate subject; the decision for a procedure is made after this assessment.
How is drainage with a Word catheter performed?
A swelling that is only cut open and emptied is highly likely to fill up again. For this reason, a thin tube with a small balloon at its tip (a Word catheter) can be placed during drainage. The balloon is inflated to keep the tube in place; while the duct of the gland stays open, the aim is for a new passage to form around it. The catheter can be used for both a cyst and an abscess. How long it stays in place varies according to your doctor's instructions.
What is marsupialisation, and how is it performed?
In this procedure the inside of the sac is emptied and its edges are stitched to the surrounding tissue to create a permanent opening; in this way the secretion of the gland can drain to the outside. In some studies, no significant difference was found between the catheter and marsupialisation in recurrence at the end of one year; the choice may vary with the hospital.
When is removal of the gland (excision) considered?
This procedure, in which the gland is removed completely, is a more extensive operation. It is considered if the cyst keeps recurring or if the other methods have not worked. Because the area is rich in blood vessels, it needs more care with regard to bleeding and wound healing.
Is surgery also performed for cysts in the wall of the vagina?
Cysts independent of the Bartholin gland, such as inclusion cysts or Gartner duct cysts, can be seen in the wall of the vagina. Whether a procedure is needed for such cysts, and which method will be used, is decided by your doctor according to the examination findings.
How do you prepare for the procedure?
Before the procedure your doctor examines you and requests tests if necessary. You should tell your doctor about the medicines you take regularly, your allergies, your previous operations and the possibility of pregnancy. Instructions such as fasting and stopping medicines are given by your doctor. The anaesthetic may be local or general depending on the scope of the procedure; the choice varies with your doctor and the hospital's practice.
How does the day of the procedure go?
The area is cleaned and the anaesthetic is given. Depending on the chosen method, an incision is made and the contents are emptied; then a catheter is placed, the edges are stitched, or the gland is removed. Whether you can go home the same day is decided by your doctor according to the scope of the procedure and the anaesthetic. If your doctor thinks it necessary, a sample is taken from the removed tissue or fluid. The operation is performed by Assoc. Prof. Dr. Nurettin Türktekin at Memorial Şişli Hospital.
What should you pay attention to during recovery?
In the days after the procedure, mild pain, swelling and bruising at the site, light fluid or bloody discharge and tenderness when sitting are considered usual. It has been suggested that a warm sitz bath may give relief, but the data on this are limited; your doctor's instructions are the basis for care. When you can use pads, bathe, have sexual intercourse, do sport and return to work varies with the scope of the method and your recovery.
Will the cyst come back, and what are the risks?
Whichever method is chosen, there is a possibility that the cyst will form again; this possibility varies with the person and the procedure performed. The general risks of the procedures are as follows:
- Risks related to the anaesthetic
- Bleeding and bruising, or a collection of blood
- Wound infection
- The catheter coming out
- Separation of the wound
- Recurrence of the cyst
- Pain or discomfort during sexual intercourse for a time
- Clot formation in the leg veins (rare)
Removal of the gland needs more caution with regard to bleeding and healing problems. It is useful to talk with your doctor at the pre-procedure consultation about the risks that apply to you.
Frequently Asked Questions
Is a procedure needed for small cysts that cause no pain?
No, generally it is not. Most small cysts that cause no pain can be followed without a procedure. A procedure is considered when the cyst grows and disturbs daily life or sexual intercourse, when an abscess forms, or when the swelling recurs.
Can a Word catheter be used for both a cyst and an abscess?
Yes. The catheter is kept in place by inflating the balloon at its tip, and while the duct of the gland stays open, the aim is for a new passage to form around it; it can be used for both a cyst and an abscess.
Is there a difference between the catheter and marsupialisation?
In some studies, no significant difference was found between these two methods in recurrence at the end of one year. Which one is chosen may vary with the hospital and your doctor's assessment.
Is removing the gland (excision) riskier than the other methods?
Because it is a more extensive operation, it needs more attention with regard to bleeding and wound healing. This method is generally considered when the cyst recurs or when the other methods have not worked.
Is the procedure done under local or general anaesthesia?
It varies. The anaesthetic may be local or general depending on the scope of the procedure; the choice is made according to your doctor and the hospital's practice.
Can I go home the same day after the procedure?
This varies with the scope of the procedure and the anaesthetic used; your doctor makes the decision.
Does a warm sitz bath help healing?
It has been suggested that it may give relief, but the data on this are limited. The instructions your doctor gives you for care should be taken as the basis.
Are tests done on the removed tissue or fluid?
If your doctor thinks it necessary, a sample can be taken from the removed tissue or fluid.
Is pain felt during the procedure?
The anaesthetic that is given either numbs the area or puts you to sleep; for this reason you generally do not feel pain during the procedure. There may be brief discomfort while the anaesthetic is being given. After the effect of the anaesthetic wears off, you may feel an ache at the site of the procedure. You use painkillers according to your doctor's recommendation.
What is done if the cyst comes back after the operation?
If you notice swelling again in the same area, you should be examined. Your doctor may recommend a different method by reviewing the previous method, the timing of the recurrence and the findings; in recurrent cases, removal of the gland may be considered.
What should be done if the catheter comes out?
The catheter coming out is a known occurrence. If you notice that it has come out, do not try to put it back yourself, and let your doctor know; your doctor decides whether it needs to be placed again or another method is needed.
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