GuidelinesOther guideline
Marsupialisation of Bartholin's Abscess
This booklet is intended as a practical guide to patient care for registrars, medical officers, interns and medical students attached to the gynaecology units at the University of the Witwatersrand Academic Hospitals. Anyone can use it.
- Lithotomy position, prepare & drape as for an evacuation
- Incise vertically the medial aspect of the abscess where the vulval & vaginal skin meets for approximately 4 cm, releasing the pus
- Digitally explore, breaking down loculations
- If necessary, remove a thin slice of redundant tissue from one skin edge with scissors
- Pass stitches from the cavity through to the vaginal skin and tie separately, at 10, 2, 4, 8 o’clock stitching the cavity open (4 vicryl sutures)
- A pack serves no purpose, does not prevent recurrence, and is painful to remove
At discharge, advise that the defect will heal, and the stitches will fall out on their own (they can be removed but it is v painful).
Bartholin’s cysts, though very different, can be managed in the same way – marsupialisation. If excision is attempted, the supplying artery may retract causing a 700ml ischio-rectal haematoma.