From the Research
Marsupialization of a Bartholin's abscess is a surgical procedure that creates a permanent opening to prevent recurrence, and it should be performed by making an incision on the mucosal surface of the abscess, draining the pus, and suturing the edges of the abscess wall to the surrounding vaginal mucosa using absorbable sutures. The procedure begins with proper patient positioning in lithotomy position and administration of appropriate anesthesia, typically local anesthesia with sedation or general anesthesia. After cleaning and draping the area, the surgeon identifies the abscess and makes an incision on the mucosal surface of the abscess, approximately 1.5-2 cm in length, as supported by the general principles of surgical management of Bartholin's abscesses 1. Pus is drained completely, and a sample may be collected for culture. The surgeon then creates a pouch or marsupial by suturing the edges of the abscess wall to the surrounding vaginal mucosa using absorbable sutures like 2-0 or 3-0 Vicryl. This creates a permanent opening that allows continued drainage and prevents reclosure. Hemostasis is achieved throughout the procedure. Postoperatively, patients should be advised to take sitz baths 2-3 times daily for a week, maintain good perineal hygiene, and abstain from sexual intercourse for 2-4 weeks. Pain management typically includes NSAIDs and occasionally opioid analgesics for 3-5 days. Antibiotics may be prescribed if there's evidence of cellulitis or systemic infection, commonly using amoxicillin-clavulanate 875/125 mg twice daily for 7 days, as suggested by general principles of infection management. This procedure is effective because it creates a new gland opening that allows continued secretion without blockage, significantly reducing recurrence rates compared to simple incision and drainage, as shown in a study comparing marsupialization and Word catheter for the treatment of Bartholin cyst or abscesses, which found that marsupialization had lower recurrence rates and higher patient satisfaction 1.
Some key points to consider when performing marsupialization of a Bartholin's abscess include:
- Proper patient positioning and anesthesia to minimize discomfort and complications
- Adequate drainage of the abscess and collection of a sample for culture
- Use of absorbable sutures to create a permanent opening and prevent reclosure
- Postoperative care, including sitz baths, perineal hygiene, and pain management
- Consideration of antibiotic therapy if there's evidence of cellulitis or systemic infection
It's also important to note that while other treatments, such as Word catheter placement, may be effective, marsupialization has been shown to have lower recurrence rates and higher patient satisfaction in some studies 1, 2. However, the choice of treatment should be individualized based on patient factors and preferences. In general, marsupialization is a safe and effective procedure for the treatment of Bartholin's abscesses, and it should be considered as a first-line treatment option, as supported by the most recent and highest quality study available 1.