Surgical treatment of Bartholin's gland. Removal of Bartholin gland cyst. Treatment of Bartholin gland cyst

Bartholin's glands are large paired glands of the vestibule of the vagina, located in the thickness of the labia majora, at their base. A Bartholin gland cyst is a formation that occurs as a result of blockage of the excretory duct and accumulation of fluid.

The appearance of pathology is influenced by various reasons, but most often the cause is infectious pathologies:

gonorrhea, caused by Neisseria gonorrhoeae;
candidiasis;
ureaplasmosis;
mycoplasmosis;
Trichomonas vaginalis;
chlamydia.

Personal hygiene influences the formation of cysts. Its absence or poor quality can lead to symptoms. Factors that cause blockage of the gland ducts include recent sexual intercourse and pregnancy.

Symptoms

The manifestation of symptoms with a Bartholin gland cyst is quite striking. The labia become swollen and painful. The patient's general health deteriorates, headaches, nausea, vomiting, and increased fatigue appear. Small formations are invisible and do not interfere with sex.

During the acute form of the disease, the temperature increases. And the tumor can reach a radius of 4 cm. With such sizes, it is possible to open the cyst independently.

Treatment

Surgery to remove a Bartholin gland cyst is performed after a thorough examination and receipt of doctor’s recommendations. Indications for surgery include:

formation of swelling of the labia minora;
purulent pathological process;
discomfort in the vulva area.

Reviews about the removal of Bartholin gland cysts are positive. One of the advantages is that there is no need for preliminary preparation. After visiting a gynecologist, you may be immediately sent for surgery, which is performed using local or general anesthesia. The choice of pain relief method depends on the recommendations of the specialist and the wishes of the patient.

If the pathological process has reached its peak and resolved itself, leaving behind pain, then in this case the glands are completely removed, and the woman is prescribed a course of antibiotics.

Not all cases indicate complete removal of the Bartholin gland. One of the methods of surgical intervention for cysts is drainage. Although drainage is a rare event, since the method can be life-threatening. When using the method, the blocked duct is closed with a catheter. It is removed only after complete rehabilitation. This method is rarely used and only when previously used methods have not yielded results.

As a method of treating cysts, marsupialization is used - this is an operation that removes inflammation of the Bartholin gland, which is of a recurring nature. According to the gynecologist, surgery to remove a Bartholin gland cyst is performed to form a new duct and connect it to the hole.

Surgical intervention is used to restore the functions of the duct, adjust its performance, eliminate inflammation, normalize its size and avoid bartholinitis.

When operating on a cyst, two incisions are made: on the swelling and on the cyst itself. After this, the incision site is thoroughly washed and disinfected. Then the formation of the excretory duct occurs. A technique is also used to open a benign formation with subsequent cleaning of the cavity. The cyst may re-form.

To prevent the cyst from forming again, special catheters are installed. They are removed only after two weeks. During this period, new ducts are formed. Thanks to this technique, benign formation does not have a recurrent nature.

To perform this type of surgery, local anesthesia is required. After the operation, the woman can go home immediately. Any sexual intercourse is prohibited for 1 month.

Enucleation of a Bartholin gland cyst is a specific surgical technology, a video of which you can find on the Internet. Improper execution has serious consequences. The operation begins with an incision from the surface of the labia minora.

Under no circumstances should they use another direction, since there is a sensitive area that loses its properties during the pathological process.

When done correctly, the edges do not diverge by more than half a centimeter. It is important to ensure that the cyst does not rupture. Such force majeure complicates further operations and requires actions for processing and cleaning of contaminants.
For suturing, 2 stitches are applied. The purpose of surgery is to remove the gland and prevent relapses.

One of the disadvantages of the operation is the large blood loss, which significantly complicates the process. Those parts that are weakened by bleeding are bandaged. Damage associated with venous blood is closed using a tourniquet. Then the applied sutures and installed clamps are removed. After all the steps are completed, the wounds become smaller and the edges are sealed with vicryl. The consequences include swelling of the vulva, which disappears after two days.

Sometimes removal of a Bartholin gland cyst is performed using a laser.

The postoperative period of removal of a Bartholin gland cyst includes strengthening immune system, monitoring personal hygiene, timely treatment of other diseases and proper nutrition.

A woman may have a Bartholin gland cyst for a long time (years) without causing any concern. It forms after suffering inflammation, trauma, and sometimes for reasons that are not entirely clear. An uncomplicated small cyst does not interfere with active sex life, get pregnant and give birth. Why and when should it be removed, what types of surgical techniques exist?

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Is it always necessary to remove a Bartholin gland cyst?

A cyst is a pathologically formed cavity, often round in shape, which has its own wall and internal contents. A similar formation is formed in the area of the Bartholin gland for the following reasons:

As a result of the inflammatory process or tissue swelling, the channel through which the gland secretions flows out occurs. As a result, fluid accumulates in a limited space and a cyst is formed.
If there is a tumor of the external genitalia, then compression can occur without an inflammatory process.

A Bartholin gland cyst is a benign formation; in the absence of complications, it does not pose a particular threat to the life and health of a woman. Therefore, often, especially with small sizes of the formation, they do not even pay attention to it. Some people are lucky and may not have problems with this all their lives, right up to old age.

In the following situations, you should consider removing a Bartholin gland cyst:

If it becomes inflamed and an abscess occurs. In this case, surgical treatment will be a necessary measure.
If the cyst periodically becomes inflamed, but goes away under the influence of local and antibacterial treatment.
In the case when the formation is large and brings discomfort, inconvenience to the girl when walking, physical activity, sexual activity, etc.
If a woman has tumors of the labia minora or labia majora. In this case, comprehensive removal of tissue from the external genitalia is recommended.
At the request of the woman, if it brings her psychological discomfort.

In the conditions listed above, a Bartholin gland cyst can cause more significant complications than just inflammation. Although it also entails a decrease in the quality of life and temporary loss of ability to work.

Treatment of Bartholin gland cyst without surgery

Under certain circumstances, conservative treatment of the cyst is possible. But it is important to understand that this can only relieve inflammation, pain, and tissue swelling, and the formation itself can only decrease slightly.

In rare cases, cysts may go away on their own. This happens if the outflow of secretions spontaneously improves.

The essence of treatment for Bartholin gland cyst is as follows. It is necessary to recreate the unimpeded secretion of viscous mucous secretion. This can be achieved with conservative measures, but more often it is necessary to perform surgery. The purpose of the latter is to form an artificial canal or simply open it with subsequent free flow of secretion. Sometimes the gland is simply removed completely.

You can do without surgery in the following cases:

if an abscess has not yet formed due to inflammation;
during the “cold period”, when the course of the cyst is not complicated by anything.

Drug therapy

Medicines are used if inflammation occurs. Goal of treatment in this case– prevent an abscess from forming when surgery can no longer be avoided. Drug therapy includes the following drugs:

Antibiotics. Ideally, their selection takes into account the seeding of discharge from the Bartholin gland canal or at least from the vagina. Most often, the initial appointment is carried out empirically, since a more detailed examination requires time.
Antispasmodics, painkillers, anti-inflammatory drugs. They can be used both internally and topically (for example, Vishnevsky ointment, Miramistin, etc.).
It is useful to apply cold to the site of inflammation, as well as to carry out sitz baths with decoctions of medicinal herbs (chamomile, calendula, mint and others).
You can supplement treatment with various physical procedures, for example, UHF, magnetotherapy and others. The inflammation will go away faster, and the risk of developing into an abscess is much lower.

Folk remedies

All recipes traditional medicine are also based on relieving inflammation, tissue swelling and restoring drainage of the resulting cystic cavity. Products are also used to strengthen the immune system in the fight against infection.

Recipe 1. You should take walnuts or hazelnuts 100 g, several large cloves of garlic, 50 g of dill seeds and pour 400 ml of liquid honey. Let it brew for 2 - 3 days and take 2 - 3 teaspoons several times a day.
Recipe 2. You should take nettle, yarrow, and elderberry in equal quantities. Pour the resulting mixture with 2 - 3 cups of boiling water and let it brew for about an hour. Use for sitz baths and douches.
Recipe 3. Chamomile and marigold flowers mixed and poured hot water. Wait until the mixture cools a little and then perform sitz baths. For effect, you can add a little potassium permanganate.

Watch the video about Bartholin gland cyst:

Surgery for Bartholin gland cyst

The most radical treatment can only be achieved using various surgical techniques. In each specific case, you should give preference to your own method. The best option Only a doctor can choose.

Enucleation of the cyst or removal of the gland completely

Some doctors choose this particular treatment method, believing that if the gland is removed, there will be no more problems. In reality it is a little different. Yes, the woman will no longer have inflammation and the formation itself. But the Bartholin gland is not an extra part in the body; it secretes a secretion to lubricate the entrance to the vagina, including during sexual intercourse. As soon as all this is removed, the woman begins to experience discomfort, pain during intimate relationships and in general in everyday life.

The operation is also accompanied by large blood loss due to the vascular anatomy of this area. Therefore, removal of the gland should be considered when other methods are impossible or no longer effective.

Regarding the enucleation of the cyst, the course of the operation and possible complications similar, but still the volume and blood loss are slightly less. But having removed the formation in this way, there is a high probability of relapse.

The essence of such an operation is as follows:

An incision is made above the formation on the side of the labia minora.
When the cyst is removed, it is carefully separated from the surrounding tissue. It is desirable that it does not rupture. Otherwise, the contents may create additional difficulties for subsequent healing, especially if the operation is performed during the formation of an abscess. But it is often difficult to keep fabrics from tearing even with very careful handling.
The cyst bed is sutured in layers. If necessary, additional hemostasis is performed - stopping bleeding.

Marsupialization of Bartholin gland cyst

This is one of the most optimal operations for effective treatment and preventing cyst recurrence. It is carried out both during the “cold” period and during the formation of an abscess.

The course of the operation is as follows:

An incision is made over the cyst and its contents are removed. You can also simply peel off the formation.
After this, special sutures are placed in such a way that a new passage is formed for the outflow of Bartholin gland secretions.

Sutures after a Bartholin gland cyst: care rules

When enucleating a cyst or marsupialization, both absorbable sutures and those requiring subsequent removal can be applied. In the presence of inflammation, the latter is preferred. The recommendations are as follows:

During the first few days, swelling of the tissues of the genital organs is possible. This causes pain and discomfort. To reduce the severity of symptoms, it is helpful to apply ice to the wound and stitches.
In order for the postoperative area to heal well, it is necessary to carefully treat it. As a rule, the seams are lubricated with an antiseptic two to three times a day.
If a turunda is installed, it is replaced daily.
The underwear should not squeeze or tug. It must be made of natural fabrics to allow air access to the wound.

Restrictions after surgery

Classically performed operations require long healing, at least 3 - 4 weeks. During this time, you should adhere to the following recommendations:

It is necessary to carefully observe the hygiene of the external genitalia and treat the wound according to the instructions of the doctor.
You should refrain from sexual intercourse until complete healing. Otherwise, when excited, there will be an increase in secretion, which can quickly lead to a relapse of the pathology.
It is worth refusing to visit baths, saunas, hot tubs, swimming pools, ponds, etc. for a while.

Laser for cyst treatment

Laser vaporization is one of the effective techniques with many advantages. However, not all clinics provide such treatment, as this requires expensive equipment.

The whole procedure takes about 10 minutes. But this treatment is carried out only outside of inflammation. The only limitation in this situation is abstaining from sexual intercourse for about a month. The catheter itself does not prevent the woman from leading a normal life.

This is a popular technique in many countries; the recurrence rate of the pathology is no more than 10%.

Bartholin gland cysts are quite common among women of all ages. There are many methods of both surgical and conservative treatment at different periods of the disease. Only a specialist can select the most suitable option in a particular situation. One of the optimal and modern species treatment is the installation of a Word catheter.

What is a Bartholin gland cyst?

The disease is a pathology of a large gland located on both sides of the vaginal opening and located in the muscles of the labia minora. The cystic tumor is separated from healthy tissue by a tight-elastic connective capsule. It appears when the ducts are partially or completely blocked, through which a viscous secretion is removed, which serves to moisturize the vagina, which is important for normal course sexual intercourse and better stretching of the walls during childbirth.

It looks like a swelling and can be very small (1-2 cm) or grow to huge sizes (6-10 cm). The contents of the cyst consist of a homogeneous liquid with a large amount of protein. As a result of a viral or fungal disease, it can become infected and begin to fester, in which case it is called an abscess.

Causes of cysts on the labia

A tumor-like formation can appear during infection of the gland and its ductal tubules with various infections, for example, Trichomonas, gonorrhea or ureaplasma, as well as with:

candidal inflammation of the vaginal microflora;
development of epidermal staphylococcal lesions;
prolonged and intense sexual intercourse;
violation of intimate hygiene rules;
tissue injury as a result of hair removal;
frequent wearing of lace or synthetic underwear that fits tightly to the organs;
carrying out medical abortion or other gynecological operations.

The risk group includes women who are promiscuous, do not use contraception and often change partners, as well as those who do not seek medical help for a long time if they have pelvic inflammation.

Symptoms of the disease

The cyst, which proceeds without complications, is a small rounded seal located at the very edge of the labia, and can be found on both one and both sides. This tumor does not cause any unpleasant symptoms and is very small in size. Sometimes, due to a lack of hydration, a woman feels dryness and discomfort during sex.

A tumor can be accidentally discovered by a gynecologist during a routine examination in a chair. When cysts grow, they can be observed discomfort when walking or running, and soreness in the part of the lip where it formed.

If an abscess develops, it appears throbbing and sharp pain. The skin at the site of suppuration is dense and tense, and the process may also be accompanied by fever, vomiting, dizziness and chills.

Bartholin cyst and pregnancy

When such a diagnosis is made to a woman carrying a child, she has serious concerns about the health of the unborn baby. What you need to know about the disease during pregnancy:

decreased immunity contributes to tumor development;
the infection can reach the fetus through the blood or amniotic sac;
a disease complicated by an abscess threatens miscarriage or premature birth;
developmental deviations are possible, for example, growth retardation;
there is a risk of contracting intrauterine pneumonia;
the ingress of pathogenic organisms sometimes causes damage to the organs of vision.

A child can also become infected while passing through the birth canal, this is especially dangerous for premature babies, their immunity is unable to cope with the disease on its own.

Diagnostics

To confirm the diagnosis, it is necessary to undergo examinations by specialists such as:

blood biochemistry and general analysis;
antibiotic sensitivity smear;
culture to determine microflora;
microscopy of vaginal discharge;
analysis for infections.

An examination by a gynecologist will show whether there is unilateral swelling of the labia, as well as their asymmetry, inflammation of the inguinal lymph nodes, and changes in tissue in the area of the cyst.

Postmenopausal women need a biopsy to rule out the development of malignant processes.

Treatment of Bartholin gland cyst

Small tumors do not require any treatment, and your doctor may advise you to simply observe the development of the disease for some time. Sometimes the outflow of secretions can recover on its own, and the capsule will dissolve without medical intervention.

If the tumor is large and significantly complicates a woman’s life, then there are several methods, including local, internal and surgical treatment.

ethnoscience

As additional remedies, recipes based on herbal infusions are used. They can be used as a drink, a douching solution, or soaked into a tampon.

Well established burdock leaf juice, to prepare it you need to take several bunches of grass and grind them in a blender, squeeze out the juice. Take a month according to the scheme: two days, 1 tbsp. l. 2 times a day, then the dosage should be increased and applied three times a day.

To relieve inflammation you need to take infusion of white acacia flowers, for this 2 tbsp. l. Brew dry crushed raw materials with a liter of boiling water, infuse and take throughout the day as tea.

Can be used for douching chamomile decoction, which is prepared from 3 tbsp. l. plants and 1.5 liters of water. The procedure is done twice a day with a solution at room temperature.

Therapeutic

Treatment of this type is prescribed to eliminate symptoms and alleviate the general physical condition, and includes several types of manipulations. Among them are the use of medications both internally and externally, as well as the impact on physical factors, that is, various procedures using current or ultraviolet light. The therapeutic approach is intended for tumor formations no larger than 2 cm, which are asymptomatic and without complications.

External

The following are used as topical agents: dosage forms, as ointments, gels and pastes, which, in turn, can be divided into emulsions, suspensions and combination preparations. Among them are usually used:

"Levomekol"– a broad-spectrum medicine that is used to treat abscesses, has anti-inflammatory properties, helps cleanse purulent wounds, and restores tissue;
"Ichthyol ointment"– the product belongs to the group of antiseptics, disinfects well, and also relieves pain;
"Gyoksizon"– excellent for eczema, dermatitis and skin inflammation;
"Vishnevsky ointment"– used in the treatment of skin suppurations or infected wounds. Promotes rapid regeneration;
"Hydrocortisone"– has a decongestant effect, relieves itching and irritation.

You can also use tampons soaked in Miramistin solution for cysts..

Physiotherapeutic

This type of treatment includes all types of influence - heating and cold, electromagnetic and ultrasonic radiation, as well as therapeutic mud and massage. For cystic formations, the following types of procedures can be used:

Galvanization– the method is based on the use of electric current with low voltage; it is contraindicated for complicated cysts.
UHF– recommended for use for purulent abscesses, prohibited for bleeding and tumors.
EHF– used for diseases caused by a general decrease in immunity, and for rapid tissue regeneration.
Darsonval– low-frequency impulses improve blood circulation and enhance lymphatic drainage.
Magnetotherapy.
Ultraviolet irradiation.

Physiotherapy is effective in the initial stages of the disease and is used as an additional remedy.

Medication

Based on what caused the disease, the appropriate treatment is selected:

antibiotics– are prescribed depending on the type of pathogen. As a rule, these drugs are Cefixime, Amoxicillin or Fluconazole;
painkillers– used to relieve symptoms – “Keterol”, “Ibuprofen”, “Nise”;
anti-inflammatory– “Adolor”, “Piroxicam”, “Voltaren”, “Dexalgin”;
vitamin complexes– “Centrum”, “Complivit”, “Alphabet”;
immune support products– “Arbidol”, “Viferon”, “Interferon”, “Amiksin”.

If drug therapy does not bring the desired result, then other methods are used.

Surgical

When a Bartholin gland cyst becomes large or its course is complicated by an abscess and interferes with leading a normal lifestyle, then surgical intervention is prescribed, depending on the condition and symptoms. It is carried out during a period when there is no acute inflammatory process; if it is present, drug treatment is required.

If after removal the tumor reappears, it is recommended to operate on it again, regardless of its size. Thanks to modern technologies healthy tissue remains intact.

Marsupialization of the cyst

After the gynecologist has prescribed this type of surgical intervention, it is necessary to undergo the following examinations:

Take a general blood test for infectious diseases.
Determine group and rhesus.
Get fluorography.
Conduct a microscopic examination of the cervix and a vaginal smear.

The operation is usually performed when other methods have not given the desired result or when there are multiple openings of abscesses. The process itself takes 30-40 minutes and takes place under local anesthesia. Where the tumor is most clearly visible (usually at the very entrance to the vagina), a semicircular incision is made. Next, a part of the mucosal tissue measuring 1-2 cm is cut out. After this, a similar incision is made on the other side of the cyst, that is, one of the walls of the neoplasm is cut out.

Everything that has accumulated in it is cleared from the capsule cavity, then this place is sanitized. Sutures are made on the walls of the cyst so that it is sutured to the tissues of the labia. To remove secretions, a catheter is inserted into the hole; over time, a duct forms there. This process takes on average 1.5-2 months. The possibility of relapse is 8-11%.

The procedure is performed on an outpatient basis, and the woman can go home the same day. You should abstain from sexual activity throughout the entire rehabilitation period.

Vaporization (evaporation) of a cyst with a laser

The meaning of this manipulation is that upon contact with the affected tissue, the laser acts on the cyst, under the influence of the released energy, the cells die and the internal contents of the tumor-like formation evaporate. In this way, the ductal channels are released, and subsequently sclerosis of the capsule cavity occurs.

The advantages of this type of exposure are the speed and bloodlessness of the procedure, the ability to preserve the gland, and the absence of the risk of damage to healthy mucous tissue.

Extirpation (resection)

A radical surgical method in which the gland is completely removed. Of course, this allows you to solve the problem once and for all, but this operation also has its disadvantages:

after the loss of the gland, vaginal dryness may occur;
the manipulation takes several hours, during which large blood loss occurs;
stitches remain;
a long recovery period, which can be complicated by deep hematomas formed at the site of removal.

The operation takes place under general anesthesia and requires a hospital stay.

Enucleation of Bartholin gland cyst

This removal method takes place under intravenous anesthesia; its main task is to restore the normal functioning of the gland and the formation of its ductal channels.

After opening the purulent inflammation, its contents are cleaned and further treated with antiseptic solutions. Then special sutures are placed, which begin from the base of the tumor upward, gradually narrowing the resulting wound.

For the first few days, it is necessary to treat the surgical site with disinfectants; if all medical recommendations are fully followed, recovery will be quick and painless.

A contraindication to surgery is the acute stage of inflammation of the genital organs.

Recovery period

After removal of a cystic formation, the following measures must be taken:

examination of the contents of the cyst for the presence of pathogenic microflora for further use of a course of antibiotics;
reception vitamin complexes to maintain general immunity;
performing physiotherapeutic procedures recommended by the doctor;
daily treatment of seams.

You should also exclude severe physical activity. It is necessary to strictly follow the gynecologist's prescriptions to avoid relapse and its consequences.

Bartholin gland cyst is a blockage of the excretory duct of the gland with the formation of a retention cyst, which can reach the size of a goose egg, create discomfort when walking, sexual intercourse and cause inflammation (bartholinitis, abscess).

INDICATIONS FOR OPERATION

The presence of a cyst that creates discomfort during sexual activity and walking.

CONDITIONS FOR THE OPERATION

Sanitation of the vagina, absence of acute inflammatory diseases in the genitals.

PREPARATION FOR OPERATION

Emptying the bladder, shaving the hair on the external genitalia.

METHODS OF PAIN RELIEF

Intravenous anesthesia.

OPERATIONAL TECHNIQUE

The operation is performed in a small operating room with the patient in the gynecological chair position. After treating the inner surface of the thighs, perineum, vulva, vagina with an alcohol solution of iodonate© or an alcohol solution of chlorhexidine bigluconate, an incision is made outward from the labia minora above the cyst. The skin and underlying tissue are dissected to a length corresponding to the size of the cyst. The cyst is removed mainly using a sharp method (with a scalpel or curved scissors), freeing it from the underlying tissue. This is facilitated by the assistant stretching the edges of the wound to achieve the necessary tension of the fiber tissues, which are crossed, keeping the cutting surfaces of the scissors facing the skin.

To prevent relapses, the remaining gland located at the posterior pole of the cyst should be removed. Enucleation of the cyst is accompanied by bleeding, which must be stopped by ligating the vessels or careful electrocoagulation. Submersible sutures are applied, starting from the bottom of the cyst bed, gradually reducing the resulting depression.

If it is not possible to reliably stop the bleeding, then it is advisable to insert a rubber or gauze graduate into the lower corner of the wound for 2 days, which will prevent the formation of a hematoma.

COMPLICATIONS

Recurrence of Bartholin gland cyst.

FEATURES OF MANAGEMENT IN THE POSTOPERATIVE PERIOD

Treat the surgical site with antiseptic solutions for 3–4 days.

INFORMATION FOR THE PATIENT

Unfortunately, many patients who suspect a Bartholin gland cyst prefer not to see a doctor. However, a long-term inflammatory focus in the area of the Bartholin gland (as in other organs) should be treated, as it can be a source of infection not only for the genital organs, but also for the entire body. Therefore, if you suspect the presence of a Bartholin gland cyst, a visit to a gynecologist is required, who will assess the situation and prescribe adequate treatment.

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