Marsupialization - Procedure, Advantages, Complications and Treatment

What Is Marsupialization?

Marsupialization is a technique that treats a cyst or an abscess; when draining, the abscess will not be considered adequate. At the same time, complete removal of the surrounding structures is not desirable. This surgical procedure is often done with Gartner's duct cysts, pancreatic cysts, pilonidal cysts, and Bartholin's cysts. It is a technique of cutting a slit into the abscess or cyst, and then the edges are sutured so that they are open and can drain freely.

What Is a Cyst?

A cyst is an abnormal fluid or air-filled sac that can form anywhere in any part of the body, such as the jaw, vagina, or lower back. It is a non-cancerous growth with fluid that is usually not painful initially. If the sac is filled with pus, the cyst will become infected and become an abscess. This may cause pain and discomfort. It has a distinct membrane and is separated from nearby tissues. Poor hygiene practices increase the risk of cyst formation. These cysts can form due to the following reasons-

1. Tumors.

2. Genetic conditions.

3. Abnormality in the organ of a developing embryo.

4. A defect in the cells.

5. Chronic inflammatory conditions.

6. Blockage of ducts in the body.

7. A parasite.

8. An injury that breaks a vessel.

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There are so many varieties of cysts, and some cysts that commonly require marsupialization are-

1. Bartholin Cysts: They occur in the Bartholin glands that lubricate the vagina.

2. Pilonidal Cysts: These cysts commonly occur in the lower back near the cleft of the buttocks.

3. Epidermal Cysts: These are small cysts that occur in the skin.

4. Dentigerous Cysts: These are cysts that occur in the jaw.

5. Lacrimal Cysts: They are cysts that arise in the lacrimal glands or the tear glands in the eyes.

6. Dermoid Cysts: They are non-cancerous cysts that have different kinds of tissues.

7. Baker Cyst: They commonly occur behind the knee and are otherwise called a popliteal cyst.

When to Do Marsupialization?

Marsupialization is not the first line of treatment. It is done when other therapies have failed, and then the patients have the following issues-

• When the cysts keep recurring.

• When it causes a lot of pain.

• The cyst is large enough to interfere with sitting, walking, or sexual intercourse.

• When the cyst becomes infected and abscessed and causes a lot of fever and pain.

• When other therapies have failed in cyst treatment.

What Is the Procedure of Marsupialization?

Marsupialization is usually done under local anesthesia in a doctor's office. Sometimes, a doctor may prefer general anesthesia also. The goal of management is to preserve the area and its function, if possible generally. It is not recommended when a Bartholin's cyst is infected and has an abscess. The procedure is done in a hospital setup, but it will not require an overnight stay in the hospital. During the procedure, the cyst is surgically opened and drained, and the edges are sutured together on either side of the incision to form an open pouch of around 6 mm, allowing the fluid to drain quickly. A thin tube or catheter is placed for a few days to drain the fluid entirely and prevent its recurrence. It is a short procedure and takes 15 to 20 minutes to complete. The surgical wound usually heals in one to two weeks.

What Is the Aftercare Advice After the Procedure?

The patients are mostly discharged on the same day after recovering from the anesthesia. Antibiotics are prescribed to prevent infection, and painkillers are given to reduce pain. It is generally advised to keep the surgical area clean and dry and follow the specific aftercare instructions given by the doctor. They can resume most of their daily procedures the next day. However, some functions like exercise, sports, or sexual intercourse need advice from the doctor.

Besides this, the patient may experience a small amount of discharge or bleeding for a few days. Patients are also advised to avoid using harsh soaps or bathing products, avoid activities that require straining, and always wear comfortable loose clothing.

What Are Some of the Advantages of Marsupialization?

• The procedure is of short duration and causes minor trauma.

• Swelling and post-operative problems are very minimal.

• Neighboring structures such as teeth, alveolar nerves, and maxillary antrum are not damaged.

What Are Some of the Disadvantages of Marsupialization?

• It requires more extended post-operative care for up to one year.

• Complete bony healing will not occur in patients older than 20 years.

• A cyst recurrence may occur if we do not use a plug or obturator. Then a second intervention is necessary.

• Only a part of the cyst lining is removed, and there are chances of missing out on some developing carcinomas in the cyst linings.

What Are the Possible Complications of Marsupialization?

According to research, Bartholin's duct cysts recur 5 to 15 percent after marsupialization. Simple marsupialization to manage oral ranula results in excessive failure and iatrogenically caused cervical ranula recurrence. Hence it is recommended that oral ranula can be initially treated by marsupialization with packing, and if it recurs, the offending sublingual gland may be excised. The possible complications of marsupialization include-

• Dyspareunia or painful sex.

• Hematoma is the blood clot and pooling near the incision.

• Infection.

• Recurrent abscesses.

• Scarring.

• Neuropathy or nerve dysfunction.

What Are the Other Treatments Available Other Than Marsupialization?

Other than marsupialization, several treatments are available to treat a Bartholin's cyst. But they are less commonly used and are not widely known. They include-

• Silver nitrate gland ablation.

• Carbon dioxide laser.

• Needle aspiration.

Conclusion

Marsupialization is a simple procedure, less invasive and hence not associated with some severe complications, and is well tolerated by patients. But one must take all the aftercare advice to help the wound heal and reduce the risk of infection after surgery. You can also consult an online medical specialist for any further information if needed.

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