Bartholin Cyst Surgery: Purpose, Procedure, Benefits and Side Effects

Bartholin Cyst Surgery is the prominent method to treat Bartholin cysts. This surgical procedure is termed marsupialisation. Bartholin glands are two tiny pea-sized glands situated on either side of the labia (vaginal lips), near the opening of your vagina. When one of the openings of these glands becomes inflamed and blocked, fluid builds up and forms lumps-like structures called Bartholin cysts.

In order to relieve the built-up fluid, the surgeon makes an incision at the location during this surgery. Then the cyst’s margins are sutured to the tissue around them to create a little pouch. This open pouch helps to empty the fluid-filled sack.

To treat Bartholin cysts that have been unresponsive towards the medication, doctors initially suggest less-invasive and surgical methods to treat or manage the condition. However, if these conservative techniques also fail then marsupialization is recommended as the last resort. There are three surgical alternative treatments available to deal with Bartholin’s gland cysts;

• Carbon dioxide laser: Using a carbon dioxide laser, medical professionals make a hole in the skin of the afflicted region and drain the cyst. The cyst is either eliminated with the laser at this point or left in place with a tiny opening that permits any remaining fluid to drain.
• Needle Aspiration: During this procedure, the cyst is drained out using a needle and a syringe. The empty space is then subsequently filled with a 70% alcohol liquid solution to lessen the risk of infection.
• Cauterization: In order to remove the fluid, doctors create an incision in the cyst. After that, they burn the formed cavity by inserting a bit of silver nitrate, creating a little lump. If the cyst remnants haven't already fallen out after two or three days, the doctor will remove the remaining silver nitrate and cyst material.
• Balloon Catheter Technique: Also known as catheter implantation, word catheter and fistulization, balloon catheter surgery is performed under local or general anesthesia. The surgeon makes an incision in the cyst or abscess to drain the fluid or mucus that is contained within a Bartholin's cyst. The surgeon will then employ a surgical tool; ccatheter with a balloon at its tip in the incision made in the cyst.

  The doctor next injects up to 4 ml of saline into the balloon (salt water). The surgeon will partially close the incision by allowing room for the catheter. The surgeon will then keep the catheter in place to let the wound heal. Near the catheter, new cells will develop in a process called 'epithelialization.' The surgeon will drain the balloon and remove the catheter following this epithelialization procedure.

If a patient has a history of recurrent Bartholin's gland cysts or if the cysts cause excruciating pain and discomfort, your doctor may advise marsupialization. In cases where other therapies have failed, it is a viable treatment choice.

The patient will first and foremost be put under general anesthesia. The surgeon will next create an incision in the cyst to allow the fluid to drain completely. He will now fold the tissue of the exposed cyst backward and suture the borders with the skin next to it on your vulva. Over time, the sutures will dissolve on its own. The outcome is a small open pouch that blends seamlessly with the skin around it and continually drains the mucus or fluid from the site.

The doctor may advise the excision of the Bartholin gland if, in certain situations, the cysts continue recurring and did not react to any therapies. Surgery to remove the bartholin glands may be necessary to treat a bartholin cyst in very rare circumstances. The whole cyst wall is removed using a surgical operation. This surgery is often carried out in a hospital setting while under general anesthesia. You should wait four weeks before engaging in sexual activity after surgery.

All the procedures are done as outpatient procedures, and as soon as the anesthetic wears off, the patient is released.

Summary- The three types of Bartholin cyst surgery are: marsupialization, surgical drainage and Bartholin cysts excision.

• Relieves pain
• Helps in treating the Bartholin’s cysts
• Improves the quality of life
• Used for the treatment of Pilonidal cysts
• Prevents infection
• Prevents recurrence of cysts

Summary- Bartholin cyst surgery helps in the treatment of cysts and relieves pain and discomfort.

It is recommended that women who exhibit Bartholin's cyst or abscess symptoms have an excision operation to alleviate their symptoms. When the operation is carried out methodically, the condition may be treated and future instances of similar problems can be avoided.

The primary determinants of how Bartholin's cysts are normally treated are totally based on the severity of the symptoms. Many individuals do not suffer any symptoms, thus in these circumstances, surgery is not necessary. While surgical intevention is only advised when Bartholin's cysts are posing major issues, such as pain when engaging in normal everyday activities like walking, sitting, or having sex.

Despite their rarity, risks involved in marsupialization include:

• Infection
• Bleeding
• Pain
• Recurrence of the cyst

People should seek emergency care if any of the following issues arise throughout the healing process:

• Loss of awareness or fainting
• Any respiratory issues, such as shortness of breath, chest discomfort, or bloody coughing

Summary- The risks of Bartholin cyst surgery are: pain, infection, bleeding and respiratory issues.

• As you will be given local or general anesthesia, depending upon your situation and type of surgery, arrange someone to drive you home after the surgery
• Empty your stomach before going for the surgery
• Clean the area with mild soap before going to hospital
• Wear loose and cotton pajamas or gown to avoid the discomfort of the clothing touching your operated area
• As it will be an outpatient operation you don’t need to take anything to the hospital with you.

Summary- You should stop taking any food items and dress in comfortable clothes before the surgery.

Keep reading to know everything about the procedure of the surgery.

Your doctor will go through the process with you and get your approval before starting it. When they:

• Make sure you're a good candidate for marsupialization, by reviewing your medical history.Talk about any dangers or potential issues.
• Provide guidelines about how to be ready for the surgery and organize your recovery.
• For instance, you might need to make arrangements for a ride home afterward depending on the type of anesthetic your doctor employs. To give yourself enough time to heal, you'll also need to ask for a leave from work.
• You will be laid down on a table in the dorsal lithotomy position. Your legs will be 90 degrees bent and supported by soft footrests as you lay on your back
• You will be administered an anesthetic to numb the area to be operated on. Marsupializations can be carried out while the patient is awake and under local or general anesthesia (whatever your anesthesiologist deems suitable)
• To avoid infection, your perineum -the area between your vaginal entrance and your anus and the surgery site will be cleaned thoroughly
• Your surgeon will make a slit along the length of the cyst, drain it, and then saturate the cyst cavity with saline solution
• Fold the exposed cyst's tissue backward and sew it to the skin next to it on your vulva. Over time, the sutures will disappear. The outcome is a small open pouch that blends seamlessly with the skin around it. Your Bartholin gland can drain continually thanks to this pouch.

Based on the different approaches to treat the Bartholin Cyst, the surgical procedures can vary widely. Here is the detailed description of each of the surgical technique to treat Bartholin cysts;

1. Carbon dioxide laser
   • The process may be finished in around seven minutes since Carbon dioxide laser therapy is less invasive. Antisepsis and local anesthetic are first applied then as it numbs the surgical site, incisions are produced using the Carbon dioxide laser, which aids in the abscess's drainage. A sterile saline solution is then used to clean the inside. The laser vaporizes and decimates the capsule tissue during the process.
   • During this procedure, cyst(s) are removed without damaging Bartholin's glands. The Bartholin's cyst is swiftly vaporized and removed using CO2 lasers, leaving the glands unharmed. There is little intraoperative or postoperative recuperation needed for this treatment, which may be done in an outpatient facility.
2. Needle Aspiration
   • A needle and syringe are used to empty the cyst during needle aspiration. It is occasionally paired with a process known as alcohol sclerotherapy, in which the cavity is emptied and then filled with a 70% alcohol liquid. This is drained out after being left in the cyst cavity for five minutes.
3. Cauterization by silver nitrate
   • A chemical compound called silver nitrate is occasionally used to burn (cauterize) blood vessels in order to stop bleeding. In silver nitrate gland ablation, a tiny, solid stick of silver nitrate is used.
   • The first step of this procedure involves an incision of the skin covering the vagina and the cyst or abscess's wall. Now the fluid from the cyst or abscess is drained out and the stick of silver nitrate is put into the empty space.
   • The cyst cavity becomes a tiny, firm lump as a result of the silver nitrate treatment. The silver nitrate and cyst remnants are either removed after two or three days, or they may just come out on their own. When first applied, the silver nitrate may burn a portion of the vulva's skin.
4. Gland Excision
   • If all the options have failed and Bartholin's cysts or abscesses keep recurring, an excision surgery to remove the afflicted Bartholin's gland could be advised.
   • This procedure typically lasts an hour and is performed under general anesthesia. You might need to spend the next two to three days in the hospital.
   • This kind of surgery has risks such as bleeding, bruising, and wound infection. If the wound does become infected, a doctor's prescription for antibiotics will typically be able to treat it.
5. Balloon Catheter surgery
   • The creation of a permanent route made during this type of surgery, allows for future fluid buildup to be drained out. Since this is an outpatient operation, you won't need to spend the night in the hospital.
   • The procedure is often done using local anesthesia, numbing the region so that you cannot feel anything. It can also be done when you are unconscious and unable to feel anything, under a general anesthetic.
   • The fluid is removed from the abscess or cyst when an incision is made. After that, a balloon catheter is placed into the empty cyst or abscess. A tiny, inflated balloon is attached to one end of a thin, plastic tube called a balloon catheter.
   • The balloon is then inflated with a tiny amount of salt water and inserted into the abscess or cyst. The balloon's size is increased as a result, filling the cyst or abscess. To hold the balloon catheter in place, stitches may be used to partially seal the incision.
   • While new cells develop (epithelialisation) around the catheter, it will remain in position. This indicates that while the wound's surface heals, a drainage tube will still be there.
   • Although it might take longer, epithelialization typically takes 4 weeks. The balloon will be emptied and the catheter will be withdrawn following epithelialization.
6. Marsupialization
   • A surgical treatment called marsupialisation may be utilized if an abscess or cyst continues recurring.
   • The cyst is first sliced open, and the fluid is then removed. The skin's margins are then sewn together to form a tiny pouch or sack, which enables any remaining fluid to drain out.
   • The treated region may be lightly wrapped in gauze once the surgery is finished to absorb fluid from the incision and halt any bleeding. Usually, this will be removed before you leave for home.
   • Marsupialization typically takes 10 to 15 minutes and is done as a day surgery, so you won't need to spend the night in the hospital. Although local anesthetic might be substituted, general anesthesia is often utilized throughout the procedure.

• Your doctor will examine your surgical wound to make sure there isn't too much bleeding
• You can often use a sanitary pad to control the bleeding from your incision, however they may choose to lightly wrap the wound with gauze
• Before your healthcare practitioner authorizes you to go home, you can spend a few hours in a recovery area
• If your pain is severe, your doctor may prescribe painkillers before releasing you or advise you to use over-the-counter painkillers
• Antibiotics may be prescribed by your doctor to treat an infection, but following marsupialization, they are frequently unnecessary
• Set aside time for a follow-up visit one week after surgery.

Treatment options for Bartholin cysts include medication, surgical drainage, and marsupialization. As a result, the total cost depends on the type of surgery, the doctor's fees, the clinic or hospital, as well as several other medical and non-medical considerations.

Both surgical procedures for Bartholin cysts; surgical drainage and/or marsupialization, involve incision of the cyst and making a drainage channel to drain the abscess. The price for Bartholin cyst surgery in IndiaThe price for Bartholin cyst surgery in India might range from Rs. 15,000 to Rs. 30,000 depending on the technique employed.

Surgery Drainage
In India, the cost of surgical drainage normally ranges from Rs 5,000 to Rs 8,000, the final price can vary depending upon the clinic chosen, doctor's fees, medicines, and other medical and non-medical charges.

Marsupialization

In India, marsupialization may cost anything from Rs. 20,000 to Rs. 30,000, the final price can vary depending upon the clinic chosen, doctor's fees, medicines, and other medical and non-medical charges.

To prevent difficulties during the healing process post-surgery, the following actions are advised:

• Avoid engaging in sexual activity and using tampons for four weeks following surgery
• Keep the afflicted region clean and dry, and wash it with warm soapy water every day. Also, wear cotton underwear and avoid wearing tight clothesAvoid intense activity, eating properly, drinking enough water, and getting plenty of rest
• Your doctor will examine the cyst walls for any tissue exhibiting indications of malignancy once your cyst has been cut. To check for cancer cells in the tissue, they might if necessary take a biopsy test to evaluate its risk of being cancer.

Summary- You should take a nutritious diet, avoid exhaustive sexual activities and take proper care of the incision areas after the surgery.

• To avoid straining while pooping, eat fiber rich food
• Drink plenty of water
• Eat food that is rich in Vitamin C, zinc, iron to boost immunity
• Include fresh fruits and vegetables in your diet to fasten your recovery
• Avoid sweets to avoid slow recovery

Summary- You should take a diet rich in vitamins, iron, zinc and fibre after the Bartholin cyst surgery.

Bartholin gland cyst surgery is a minimally invasive surgery and is treated under sedatives. A Bartholin gland cyst might bleed upon removal since the vulva has a rich blood supply yet it is the best course of action for this is surgery. Bleeding typical to some procedures only. Also, there are very minimal chances of any kind of infection and if it does happen antibiotics will typically be able to treat it.

Bartholin cyst surgery in itself isn’t painful as you will be operated under local or general anesthesia, however you can have pain and discomfort in your vulva after the surgical procedure for a few days. For this you will be provided with over-the-counter painkillers.

Also, sitting for a longer time might be uncomfortable for you after the surgery. You can also feel pain if your pee comes in touch with your wound. However, all of these discomfort will be gone once the wound starts to heal.

When it comes to cleaning and caring for your wound, follow your doctor's recommendations. The wound from Bartholin Cyst surgery will typically recover in two to four weeks. Your recovery from the surgery will take the following mentioned course;

• Every day, you should anticipate feeling stronger and better. However, you can tire easily and require pain medication for a week or two
• Your wound may be unpleasant and painful over the following day or two, but it should gradually start to feel better
• You might need to take one or more sitz baths every day for the following three to five days. Sitz baths help your wound recover while soothing it
• You could have a little vaginal discharge or bleeding during the next two weeks. The bleeding should be controlled using a panty liner.
• Additionally, you could find that you become tired quickly and need to take painkillers frequently

Throughout the healing process, you may encourage healing by:

• Taking medicine as directed
• Wearing comfy, loose-fitting underwear or pants
• Eating well and getting plenty of water
• Getting enough rest and avoiding overexertion

Summary- After Bartholin's cyst surgery, recovery could take one or two months.

Although problems are infrequent, marsupialization has risks much like any other procedure. Some of the complications are:

• Pain
• Infection
• Scarring
• Hematoma (blood that collects at the surgical site)
• Pain during sexual activity (dyspareunia)

Summary- The side effects of Bartholin cyst surgery are: pain, scarring, infection and hematoma.

There are several post-surgery instructions you must adhere to in order to ensure that the operated area recovers more quickly and effectively:

• Sitz Bath: Take a sitz bath within 24 to 48 hours, if possible, or as instructed. After you've taken off your packing, have a sitz bath. To reduce discomfort and swelling, taking a sitz bath could be beneficial It is advised to take 3 to 4 sitz baths every day for 3 days. Make sure a fresh towel is positioned to cover the bathtub's bottom. Step inside your bathtub and fill it with warm water all the way to your hips. Take a 10-minute bath while sitting
• Warm compresses: It is used to encourage drainage after Bartholin cysts surgery, which in return speeds up recovery. Warm compress can destroy germs and also reduce the chances of infection and irritation
• Sanitary Pad for discharge: Make sure you are wearing sanitary napkins to catch any discharge from your wound caused by the Bartholin cyst
• No physical intimacy: For a few weeks, refrain from having any sexual relations. Ask your doctor whether you may have sex after your surgery. Your drain can come out as a result of sexual activity. It could also infect the surgical wound
• Maintain good vaginal hygiene: It's crucial to practice good vaginal hygiene. Wipe from front to back whenever possible. Don't forget to take a daily shower. Immediately after you finish showering, gently pat the area dry

Summary- Post-treatment guidelines for Bartholin cyst surgery are: take a healthy diet, clean your wounds properly, and avoid sexual activities.

Bartholin Cysts are readily treated with medicine, and they may even be treated at home if they're very small. However, a surgical intervention may be required in a condition where the medicine is unable to cure the cysts, they are huge and painful, or if they consistently return.

If you experience a cyst beyond the age of 40 or after menopause, seek medical assistance. To establish if the cells are malignant, a biopsy may be done.