PREOPERATIVE DIAGNOSIS: Left recurrent Bartholin’s cyst.
POSTOPERATIVE DIAGNOSIS: Left recurrent Bartholin’s cyst with abscess formation.
PROCEDURE PERFORMED: Marsupialization of left Bartholin’s cyst.
SURGEON: John Doe, MD
ANESTHESIA: General.
COMPLICATIONS: None.
ESTIMATED BLOOD LOSS: Negligible.
INDICATIONS FOR PROCEDURE: The patient was brought to the operating room for treatment of recurrent left Bartholin’s cyst. The patient is (XX) years of age. She has had a history of multiple problems related to previous bartholinitis and Bartholin’s abscess and cyst formation. The patient had an initial episode of a Bartholin gland infection with abscess formation treated with incision and drainage. She was asymptomatic. She had a recurrent left Bartholin’s cyst and was treated with Word catheter placement. She developed a recurrent painful enlarging gland. After careful discussion of all alternatives and risks and benefits, marsupialization was recommended and the procedure planned. The patient was admitted for the procedure.
ANATOMICAL FINDINGS: At the time of surgery, a left Bartholin’s duct cyst was present, measuring approximately 4 x 4 cm in size. The site of the previous Word catheter placement was totally occluded. This occlusion was complete with scarring. On incising the gland, the cyst contents were filled with purulent material and a large volume of chocolate, old blood consistent with previous bleeding into the gland. Some hemosiderin deposits were noted involving the lining of the gland.
DESCRIPTION OF PROCEDURE: The patient was brought to the operating room and given adequate general anesthesia. She was examined confirming the presence of the Bartholin’s cyst. The bimanual examination was unremarkable. There were no other vulvar lesions. She was then prepped and draped in the usual manner.
The cyst was outlined and noted. Sterile gauze was placed in the vagina to prevent any contamination. The large cyst was then incised outside of the hymenal ring on the vaginal mucosa. Cultures were obtained. The incision was then enlarged to approximately 3.5 cm, and the purulent chocolate drainage was noted. The cyst was then liberally irrigated with the use of an Asepto syringe and normal saline. There were no loculations. Minor inflammatory changes were noted involving the cyst wall. A biopsy of the cyst wall was obtained and sent to pathology.
At this time, the elliptical incision was then sutured in the classical fashion, suturing the mucosal lining of the cyst to the skin with interrupted 3-0 Vicryl suture at strategic intervals approximately 0.5 cm apart. Good hemostasis was achieved. The cyst was further irrigated with the use of normal saline. Good hemostasis was present, and no further procedures were performed. All instruments were removed. All gauze packing was removed from the vagina and the vagina irrigated. No further procedures were performed. The patient was stable at all times. The patient was returned to the Same Day Surgical Unit in stable and satisfactory condition.
In summary, the following procedures were performed: Marsupialization of left Bartholin cyst and biopsy of Bartholin cyst wall.
