The surgical procedure of marsupialization involves the creation of a permanent exit to a cyst. A quick and relatively simple undertaking, the procedure often requires only local anesthetic. The procedure involves an incised opening that is held open by sutures. Cysts of the Bartholin glands, in particular, are commonly treated by the marsupialization method.
Cysts develop in glands if the normal exit of fluid from the gland is blocked. This increases the size of the duct and gland as the fluid secreted by the gland, such as sebum, is trapped and builds up behind the blockage. The procedure involves making a new, permanent exit for the fluid.
An example of a condition that is often treated by marsupialization is a cyst of a Bartholin gland in the vagina. These glands are located on both sides of the inner lips of the vagina. Usually, they cannot be felt, but cysts of the glands can grow to as much as 3 cm (1.2 inches) in size.
First, an incision that cuts through the outer skin and the inner cyst wall is made. This allows the internal fluid to escape. A wedge of flesh is then cut away in an oval shape from the cyst wall and the skin above.
To prevent the cut from healing back over the cyst so it recurs, the doctor must make the opening permanent. This is achieved by folding back the sides of the cut and sewing them to the surrounding skin to create an opening to the gland. If a doctor simply lances one of these cysts by making an incision that is not sewn open, the cyst can recur.
With marsupialization, the cyst does not usually close back over. The stitches on the sides of the incision can be made from biologically absorbable material, which do not need removal. As time goes by and the incision heals, the sides of the wound become smaller and tighter.
This form of surgery typically only necessitates local anesthetic to the area instead of a general anesthetic. In the case of a Bartholin gland cyst, the doctor can perform it in the general practice office, and the entire procedure takes only about 15 minutes. Hospitals can also perform marsupialization procedures. This form of cyst treatment can be the first one performed, or it may be used as a secondary treatment where other techniques have not worked efficiently. A similar procedure, called a window operation, is a newer technique than marsupialization that involves a larger incision with a lower risk of it becoming obstructed.