Bartholin gland cyst postoperative period. Bartholinitis: how is the operation and the postoperative period

Update: October 2018

Bartholin's gland cyst is a fairly common pathology among young women 30-35 years old. If the formation is small, then it does not bother the woman and even remains undiagnosed. But in the case of an increase in the size of the cyst, characteristic complaints appear and a lot of inconvenience arises - from discomfort during intercourse to the inability to lead an active lifestyle. Therefore, it is necessary to carry out timely and high-quality treatment of Bartholin gland cysts.

From an anatomy course

On the eve of the vagina there are a large number of functioning glands, the task of which is to protect the vulva from infection and injury, as well as moisturizing during sexual contact. The glands of the vulva constantly produce a secret that not only moisturizes the external genitalia, but also removes pathogenic microorganisms and various microparticles from them.

Among the glands of the vulva, a huge role is played by the Bartholin glands, which are located in the depths of the labia majora, mainly in the lower third of the vestibule of the vagina. Bartholin's glands are a paired organ, have a rounded shape and, in the absence of pathology, are not visible or palpable. In size, the Bartholin glands do not exceed 1.5 - 2 cm. The orifices of the excretory ducts of these glands are located on the inside of the labia minora.

What is this

When the excretory duct of the gland is clogged, the viscous and viscous secret that it forms begins to accumulate in the gland, stretching its walls, resulting in the formation of a cyst - a cavity filled with a secret. Features of Bartholin gland cysts:

• can reach significant sizes (up to 7 - 8 cm);
• are formed more often on one side (bilateral cysts are a rare phenomenon);
• have a benign nature and do not degenerate into cancer;
• do not affect the course of pregnancy and the condition of the fetus;
• do not disturb the hormonal balance;
• are not inherited;
• often recur.

Causes and mechanism of education

The reasons for the formation of a cyst are either its infection, or the creation of a mechanical obstacle in the excretory duct of the gland.

Infection of the gland can be caused by both specific microorganisms and non-specific ones. Specific pathogens include:

• gonococci;
• chlamydia;
• trichomonas;
• ureaplasma and others.

Nonspecific pathogens include representatives of opportunistic flora, which are activated under the influence of predisposing factors:

• coli;
• streptococci;
• staphylococci;
• proteus and others.

Predisposing factors

The following circumstances can provoke the formation of a cyst:

• weakened immunity;
• neglect of the rules of personal hygiene;
• wearing tight underwear made of synthetics;
• the use of lubricants (they clog the ducts of the glands, and not only Bartholin's);
• incorrect washing technique (the procedure should be performed under running water from front to back);
• wearing tight clothing (tight jeans or trousers);
• bacterial vaginosis;
• hypothermia of the lower half of the body;
• promiscuous sex life (high risk of infection);
• stress;
• rough sex;
• epilation in the bikini area (skin damage);
• gynecological manipulations that damage the mucous membrane of the vagina and vulva (abortions, hysteroscopy;
• chronic gynecological (cervicitis, adnexitis, endometritis) and general diseases (tonsillitis, caries, pyelonephritis);
• immunodeficiency states;
• endocrine pathology (diabetes mellitus).

Mechanism of education

When an infection enters the vulva, the vulva becomes inflamed. The infectious process also captures the excretory channels of the Bartholin glands, causing canaliculitis. In this case, the outlet is clogged, and the secret produced by the gland begins to accumulate inside and a cyst forms. If the contents of the cyst suppurate, an abscess of the gland develops.

It is possible to form a cyst without the participation of pathogenic microorganisms. In this case, the excretory duct is blocked by strongly overgrown surrounding tissues, which is caused by mechanical damage to the mucosa and its subsequent healing (hyperplasia or fibrosis).

Clinical picture

The size of the Bartholin's gland cyst can be different, from a pea to a hen's egg. The clinical picture develops when it reaches an impressive size, when the cyst begins to cause discomfort and disrupts the usual way of life. Small formations are asymptomatic, and only in case of inflammation of the Bartholin gland cyst do complaints appear.

Large formations cause pain during movement (walking, squatting) and discomfort during sexual intercourse.

A gynecological examination reveals the asymmetry of the genital fissure - on the one hand, the labia majora is enlarged (a consequence of inflammatory edema). If the cyst is large, then a rounded formation is determined, which rises above the unchanged skin color. On palpation, the formation is painless or sensitive, elastic in consistency and mobile (not soldered to the skin).

If the cyst is dominated by an infectious process, the clinical picture changes. Infectious agents penetrate into the excretory duct of the gland, causing inflammation in it - canaliculitis. There is a narrowing of the duct, but it does not completely clog, therefore, when squeezing the inflamed area, a few drops of pus are released. The patient complains of slight pain in the affected area, a dense roller is felt in the labia minora, and redness of the orifice of the excretory duct of the gland appears.

In the absence of a medical duct, it is completely stenotic (closed) and the exit of pus to the outside becomes impossible. It begins to accumulate inside the duct, pushing the gland to the side, which is called a false abscess. A characteristic clinical picture develops: a sharp pain when moving and touching the labia, their bright hyperemia and swelling, symptoms of intoxication. False abscesses often spontaneously open and empty, as a result, patients do not go to the doctor. But as the opened abscess heals, the inflammatory process becomes chronic and sluggish, which leads to the final blockage of the excretory duct and the secondary formation of a cyst.

If the infection affects the tissue of the Bartholin gland, then its purulent fusion occurs - the formation of a true abscess with pronounced symptoms (sharp and throbbing pain, huge sizes up to 10-15 cm, hyperemia, intoxication).

Diagnostics

It is not difficult for a doctor to make a diagnosis: "Bartholin's gland cyst". The initial gynecological examination confirms the suspicion (characteristic round and elastic mass, mobile and slightly painful on palpation).

Assigned laboratory tests:

• vaginal smear;
• general blood and urine tests;
• blood biochemistry;
• PCR diagnostics (detection of latent sexual infections);
• bacterial seeding of the contents of the formation to determine the pathogen and determine its sensitivity to antibiotics.

Treatment

The tactics of treatment is determined by the size of the formation, the presence of complaints and possible complications. If the cyst is small, no more than 2 cm, then dynamic observation is preferred. Very often, small cysts resolve on their own. Bartholin's gland cyst can be eliminated without surgery in two cases:

• the initial stage of inflammation is canaliculitis, when the process has captured only the duct of the gland, and the gland itself is not inflamed;
• small sizes (up to 3-4 cm) of cysts in the "cold" period (no inflammatory signs).

Conservative therapy includes:

• Limitation of physical activity

• Cold on the perineum

Apply an ice pack wrapped in a cotton towel to the inflamed labia for 20 to 30 minutes, taking breaks of 20 minutes. Cold constricts blood vessels, which prevents further spread of the infection and reduces swelling at the site of inflammation. In addition, exposure to cold eliminates pain during inflammation.

• Local procedures

They have an anti-inflammatory effect. It is recommended to take sedentary warm baths with disinfectants (solution of potassium permanganate, chlorhexidine or miramistin). Take baths for 10 - 15 minutes from 4 to 6 times a day. You can also apply lotions with a solution of table salt to the inflamed area (dissolve 3 tablespoons of salt in a liter of warm water). Lotions are applied for 20 - 30 minutes every 6 hours. It is allowed to use ointment applications with levomecol (anti-inflammatory effect). But applications with ichthyol or Vishnevsky ointment should not be used categorically. Ichthyol and Vishnevsky's ointment have a warming effect and will only increase inflammation (the transition of canaliculitis to an abscess), so they are prescribed before the planned surgical intervention to accelerate the maturation of the abscess.

• Antibiotics

The circulatory network is well developed in the tissues of the vulva, so the infection spreads very quickly. The earlier antibiotic therapy is prescribed, the lower the risk of transition of canaliculitis to suppuration of the gland. Until the results of the tank. sowing the contents of the cyst, broad-spectrum antibiotics (fluoroquinolones, cephalosporins, macrolides, penicillins) are prescribed. If necessary, according to the results of the analysis, a change of antibiotics is carried out. The course of treatment is standard and is 7 days.

• Non-steroidal anti-inflammatory drugs

Ibuprofen, indomethacin and other NSAIDs are recommended. These drugs not only reduce inflammation, but also have an analgesic effect. If necessary, other types of analgesics and antispasmodics are prescribed.

• Immunomodulators and desensitizing drugs.

To strengthen the immune system, viferon, tincture of Eleutherococcus, tincture of echinacea, thymalin and other immunomodulators are prescribed. Antihistamine (antiallergic) drugs reduce swelling and itching (suprastin, claritin).

• Physiotherapy

It is carried out with the relief of an acute inflammatory process (UVR and UHF, magnetotherapy and infrared laser irradiation).

Traditional medicine methods

Folk remedies are used simultaneously with therapeutic treatment. They help relieve swelling and reduce inflammation, and also stimulate the immune system.

Recipes to strengthen immunity:

• 1 recipe

Grind 100 - 150 gr. walnuts, a teaspoon of dill seeds and 3 - 4 cloves of garlic in a blender. Mix with half a liter of liquid honey and leave for 2-3 days. The mixture is taken 2 teaspoons three times a day before meals.

• 2 recipe

Grind 200 gr. aloe leaves (about 20 pieces) and mix with half a liter of honey and half a liter of red dessert wine. Mix the resulting mixture and cook in a water bath for about an hour. Then strain the mixture and take 2 teaspoons three times a day before meals. Store the mixture in the refrigerator.

• 3 recipe

Prepare a decoction of valerian root, pine buds, walnut leaves and herbs (1 tablespoon of each plant per liter of boiling water, boil for 10 minutes, then leave for 4 hours). Strain the broth and drink 1/3 cup twice a day.

For local treatment:

• warm baths from medicinal herbs (chamomile, calendula, eucalyptus);
• infusion of nettle, yarrow and elderberry (a tablespoon of each herb pour 3 cups of boiling water, leave for 2 hours) - use for sitz baths;
• pour boiling water over chamomile flowers and marigolds, leave for 2-3 hours, strain and carry out warm sessile baths.

Surgery

Surgical treatment of this pathology is carried out in the case of:

• a significant size of the cyst, which causes discomfort and disrupts the usual way of life;
• the occurrence of an abscess (the operation is performed according to emergency indications);
• periodic inflammation of the cyst, which requires conservative therapy;
• at the request of the patient (education causes psychological discomfort).

In the presence of a Bartholin gland cyst, several surgical techniques have been developed and are actively used.

Marsupialization of the cyst

The most popular surgical technique is marsupialization of the cyst. It is performed under local anesthesia. The cavity of the cyst is opened and its contents are evacuated. Then the cavity is treated with antiseptics, and the walls of the formation are sutured to the edges of the wound in such a way that the mouth of the newly formed excretory duct is formed. Such an operation makes it possible to preserve the functioning Bartholin's gland. The operation is performed on an outpatient basis and lasts about half an hour.

Enucleation of a cyst

Enucleation of a cyst is a rather complicated and traumatic operation that requires hospitalization and is performed under general anesthesia. Having captured and lifted the skin with tweezers of the labia minora, a neat incision is made without touching the formation capsule. The cyst is carefully exfoliated from the adjacent tissues as a whole. But its rupture is possible, which makes it difficult to heal the postoperative wound. In addition, the risk of large blood loss is high. Then the formation bed is sutured in layers. The recovery period is long, up to 3-4 weeks. A postoperative scar can tighten the skin, causing pain and disrupting the appearance of the vulva. The advantage of this operation is the impossibility of re-formation of the cyst.

Laser vaporization

Unfortunately, cyst vaporization with a laser is not carried out in every clinic - the method requires special equipment. The essence of the operation is to convert the light energy of the laser in contact with damaged tissues into heat. As a result, evaporation (vaporization) of the cystic contents occurs and the clogged duct is released. And under laser exposure, the cystic cavity collapses and becomes sclerotic.

Advantages of the method:

• high accuracy: the action of the laser is reflected only on damaged tissues, without touching or injuring healthy ones;
• bloodlessness: laser radiation immediately cauterizes blood vessels, preventing bleeding;
• painlessness: the laser cauterizes the nerve endings;
• regulation of the penetration depth of the beam and its power;
• speed: the procedure lasts from 5 to 20 minutes (depending on the size of the cyst);
• hospitalization is not carried out;
• absence of cosmetic defects after treatment;
• preservation of the Bartholin gland;
• the risk of recurrence is practically reduced to zero.

Insertion of the Word catheter

The word catheter is an American novelty. The catheter looks like a thin silicone tube with a small balloon at one end. The balloon can inflate up to several centimeters. A small incision of about 3–5 mm is made above the pole of the cyst, the contents of the formation are removed, and the cyst cavity is washed with disinfectant solutions. A catheter is inserted through the incision into the cyst and its balloon is inflated, which prevents the catheter from falling out of the cystic cavity. Wearing a word catheter for a long time, up to 5-6 weeks, during this period a new excretory duct is formed and epithelialized. The catheter is then removed. After the removal of the silicone tube, the walls of the resulting excretory canal can no longer grow together (they are covered with new layers of the epithelium).

Manipulation is performed in 10 - 12 minutes. Such treatment is carried out only in the "cold" period and requires the observance of sexual rest during the entire time the catheter is worn. The risk of recurrence is minimal, no more than 10%.

Cyst puncture

Puncture of the cyst has only a temporary effect. The skin over the formation is anesthetized with local anesthetics, and then the cyst is pierced with a thin and long needle. The content is draining. A similar technique is used during pregnancy, when it is impossible to perform another surgical intervention. After puncture, after some time, the cyst is formed again (the patency of the duct has not been restored).

Cyst piercing

It is also a relatively new method of treatment. The principle of the technique coincides with the installation of a word catheter. Only instead of a silicone tube, a ring is inserted into the incisions above the cyst. When piercing a formation, 2 channels are created at once, which reduces the likelihood of recurrence by 2 times. The procedure is painless and does not cause inconvenience when wearing the ring.

Gland extirpation

The operation "extirpation of the gland" means its complete removal. This is a radical method and is performed when other operational methods are ineffective.

Disadvantages and risks of gland extirpation:

• requires hospitalization;
• performed under general anesthesia;
• increased risk of bleeding during surgery;
• the formation of postoperative fistulas or hematomas is not excluded;
• requires the imposition of internal and external seams;
• an expensive operation.

The positive aspect of this operation is 100% - a guarantee of recurrence (there is no gland - the possibility of cyst formation is excluded). But removal of the gland significantly reduces the quality of intimate life, especially in young women (vaginal dryness, lack of lubrication, trauma to the perineum and pain during intercourse).

Postoperative period

After surgical removal of the cyst, it is necessary to undergo a postoperative course of treatment, which includes:

• antibiotics;
• anti-inflammatory drugs;
• applying cold to the wound in the first hours and days after the operation (stops pain, reduces swelling);
• processing of seams 2 - 4 times a day with antiseptics;
• dressings with levomekol (wound healing and anti-inflammatory effect);
• physiotherapy procedures (1-2 weeks after surgery).

In the future (next 4 weeks), a number of recommendations should be followed:

• sexual rest;
• refusal to take baths and visit baths and saunas;
• wearing non-constricting cotton underwear;
• observance of intimate hygiene.

Question answer

Question:
I have a Bartholin's gland cyst about 3 cm. It doesn't bother me. Is it necessary to remove it?

If there are no complaints and there are no signs of inflammation, then you can observe the formation, but taking into account the course of antibiotics and anti-inflammatory therapy.

Question:
I'm planning a pregnancy, passed all the tests. The gynecologist found a Bartholin gland cyst about 5 cm in diameter in me. What to do?

It is necessary to get rid of the cyst before conception, and by surgery. During pregnancy, it can fester (decreased immunity), which will require an emergency operation and the appointment of antibiotics, which are not always safe for the fetus.

Question:
When are sutures removed after Bartholin's cyst surgery?

The sutures are removed on the 6th - 7th day.

Question:
What are the contraindications for surgical treatment of vulvar cysts?

The operation is not performed for acute or exacerbation of the chronic process of the genitourinary system and for skin diseases in the perineum.

This happened to me for the first time in March 2017. Out of nowhere, a neoplasm appeared in the region of the labia majora. Increasingly, every day the pain became more pronounced, and the size of the "bumps" increased. The first days I did not pay much attention, thinking that this was a temporary phenomenon such as "pimple or herpes". But the inflammation progressed until I noticed an increase in temperature, and the size of a bump in the labia reached the size of a plum. It was then that I rushed to the nearest gynecological office, where they gave me all the information about this disease. Before, of course, I read a lot of information on the Internet and the suspicion was precisely on bartholinitis. For the first time I heard that such sores exist in the already complex female body. The gynecologist confirmed this to me and prescribed conservative treatment, because. At the time of treatment, 4 days had passed, there was no abscess. The local treatment turned out to be effective for me this time, after 10 days the inflammation disappeared, BUT - the 1.5 cm ball remained the same.

I was treated with such drugs as: doxycycline (an excellent remedy, a Russian-made drug, no problems with the intestines, even without resorting to additional treatment like Linex), levomikol at night on a gauze swab, terzhinan suppositories (only for prevention, so that there is no thrush, for the treatment of bartholinitis - hopelessness) and trichopolum.

Then, of course, I gave up on going to the doctor, hoping that the ball might not become inflamed at all, who knows, maybe it will resolve itself. To know, of course, I knew that this cyst was unlikely to disappear, I had read a lot of everything on the Internet. But the operation sounded like something terrible to me. I thought that in my case, surgery would be superfluous and no one knows how else it will turn out. The warm season came, and the cyst did not bother me. The size of the cyst also did not increase. Exactly six months until August 2017. Then - the second inflammation, which led me to the doctor again. The obstetrician-gynecologist referred me to the surgeon, warning that I was "sitting on a powder keg", and one day, in the wrong place and at the wrong time, "somewhere in the south" she would make herself felt. That is, I understood that re-inflammation indicates that it will not stop now until the operation. From the words of the obstetrician-gynecologist who consulted me, one thing was clear - with each new inflammation, the size of the cyst will increase and it will not give me rest, becoming inflamed more and more often.

And so I decided to have surgery. But this process was also long in coming, and since August inflammations have been going on one after another, every 3 weeks. The cyst increased, but when I felt it, I did not understand why - I will tell below. Initially, I applied to a paid clinic, and I also planned the operation there. But the announced cost was too big for me, and I turned to the district clinic in Moscow under the MHI policy.

I was put on a waiting list. Tentatively, the operation was planned a month after my initial appeal and the delivery of all necessary tests. During this time, I experienced another inflammation, the fifth in a row. She cured him locally, as always, with the same Trichopolum and doxycycline, she no longer applied to the clinic for help and was waiting for the operation. During all this time, I was prescribed the same treatment, I never had abscesses, the cyst was amenable to conservative treatment during inflammation. The most important thing was to start treatment on time, which I did not do the first time, waiting for the extreme point, this, most likely, provoked the formation of the cyst itself.

Arriving in time for my turn at the district hospital, I was hospitalized the day before the planned operation. In the evening have made 1 enema. Didn't do it in the morning. I was very afraid that I would have to wait for the operation all day until the evening, because. the number of incoming patients per day rolls over, many have emergency situations. But I got lucky. I was taken to the operation at 12 noon. They laid him naked on the operating table. While I was waiting for the surgeon, lying with my legs up and looking at the ceiling, to be honest, I almost gave my soul to God. I was shaking. The doctor was late due to bleeding in another patient. The anesthetist and nurses were kind even though the hospital is free. Anesthesia was made general. The operation is not the first in my life, at the age of 14 I somehow ended up in the hospital in an ambulance with appendicitis. Since then, 10 years have passed.

So, back to the operation itself. After half an hour of my thoughtless torment, I was "sedated". I didn't feel or hear anything during the operation. I dreamed something and everything. I woke up already in my room with acute pain in the perineum to the screams of doctors, apparently it was hard to get me out of sleep. My first phrase was - "give painkillers." The pain is really excruciating. The first hours, until I was injected with an anesthetic, I tossed and turned, got up, did not know where to put myself, even climb the wall. But it didn't get easier. Even after the injection, if only just a little bit. I recovered from anesthesia quickly, in 10 minutes. I could not fall asleep again.

This state of affairs lasted all day. I suffered in the truest sense of the word. Didn't eat until evening. The operation lasted over an hour. According to the surgeon who visited me later, the cyst had grown all over the gland, it had an oval shape. With each new inflammation before the operation, I felt it. To the touch, it remained the same size, but the pain went into the anus more and more. So my 5 inflammations made it bigger, it grew very deep. From the words of the surgeon, I also understood that the husking was performed with the removal of the entire gland completely. Hence the duration of the operation. The surgeon himself until the last thought that the cyst was 1-2 cm, until he did an autopsy. She just didn't feel up.

On the same day, after the operation, she noticed heavy bleeding, for which she was not at all ready. Well, how plentiful, perhaps it can be compared with 2-3 days of heavy menstruation. The surgeon said it was normal for me. After dinner, my torment in the hospital bed continued. I was sure that a sleepless night was guaranteed to me. But oddly enough, I fell asleep. Apparently she was so tired from this pain during the day that she could no longer stay awake. And for the better. In the morning I felt much better. The pain, alas, did not disappear completely, but I felt better. I could basically walk right away. After the operation, when they brought me, I got up and went to the toilet. On the second day, for breakfast, lunch, dinner, I went to the other end of the corridor normally. Of course, it looked like after childbirth, the legs were spread apart, the movements were uneven, but still I walked and felt better. In the morning the surgeon examined me, removed the tampon from the vagina with levomikol, and then I felt even better. I slept during the day. Finally!

In the following days, it became easier for me and after a couple of days I was discharged with an open sick leave. The wound bled profusely for a couple of days, then less. Going to the toilet, especially in a big way, was a problem. But it's not as bad as I originally thought, after reading reviews on the Internet. I stayed at home for only a week and was discharged to work. In principle, she walked and sat already well, without much effort and pain. I got stitches that won't dissolve on their own, so I'll have to remove them.

What can I say as a conclusion from my whole situation. If I had started treatment right away, most likely the cyst would not have formed, but who knows. All of us, girls, women, the body is very individual. I heard about cases when this cyst in someone disappeared completely and forever spontaneously, in someone - for a certain time and reappeared. Also after surgery. In one, everything heals quickly, in 10 days, the other suffers for months. In any case - do not start the disease. There are also such sores that we may not know about. Do not sit and wait until the inflammation fester and it will be too late. I never got to the point of an abscess, but I heard that this is a hell of a thing, many times worse than the operation itself for complete husking. And if this problem is already tormenting you - decide and remove the cyst, preferably together with the gland. I consulted with many doctors, incl. in paid clinics, good-rated clinics. A qualified surgeon will tell you one thing - remove everything along with the gland. This body performs only 1 function - lubrication during sexual intercourse. It does not carry any other functions. If a cyst has formed there at least once, this means that it is completely working incorrectly, which entails the formation of relapses after the removal of a cyst without a gland again and again. Are you ready to endure such pain after surgery every time? Personally, I don't.

Initially, in a free clinic under the MHI policy, they wanted to remove only the cyst and form a new duct in the gland (according to the doctor). But since the cyst had grown throughout the gland, there was no point in leaving the organ. This is probably for the best, because this is a 100% result that will never lead to the formation of relapses. Today is 2.5 weeks from the date of the operation, I'm going to remove the stitches. Sexual rest for a month is recommended, but I'm not sure that this will be enough. After the operation, a hematoma formed and the entire labia was terribly swollen. Now all this is gone. Minor pains are present, of course. But this is heaven and earth compared to what it was 2 weeks ago. At first, there will be a seal in the area where the cyst was previously palpated, but as I was told, for the first 2 months this is normal. The bleeding has finally stopped. I hope the stitches will be removed painlessly and further recovery will be quick and successful. Next, I plan to treat the cause of this disease in order to avoid the same situation on the second lip on the right side. As a treatment, I was prescribed a complex bacteriophage, we introduce a tampon at night. The thing is expensive, but 1 vial is enough for a week (this is the duration of treatment). According to the survey, no infections were detected, everything is in order with the immune system. The doctor said that most likely a bacterium entered the vagina from the intestines and "evil was born", which led to the formation of an ailment. In any case, you won’t wish this on your enemy. Appendicitis is resting here. God forbid anyone to go through all these torments. So girls are treated, do not start up and take care of yourself.

December 2017. Almost suffered all year (and many suffer for years.

All good health!

Excision of the Bartholin's gland is called "the bloodiest of small operations in gynecology." It is indicated for persistence and recurrence of abscesses or cysts of the Bartholin's gland. The key to successful resection is the control of hemostasis of the abundantly supplied gland.

The goal of the operation is the complete removal of the Bartholin's gland.

physiological consequences. Bilateral removal of the Bartholin's glands stops the secretion of fluid that moisturizes the vagina. With sufficient estrogen saturation of the body, this is not a clinical problem.

Warning. Careful hemostasis is required. When excising the gland, the branches of the pudendal artery are often damaged. They should be carefully found, grasped with clamps and bandaged, otherwise a postoperative hematoma of the vulva may form.

METHOD:

The patient is placed on her back in a lithotomy position; the perineum is treated and covered with surgical linen.

Gently perform a rectovaginal examination to determine the size of a cyst or abscess of the Bartholin's gland.

For effective hemostasis, it is necessary for the surgeon to know the peculiarities of the blood supply to the labia and vagina.

The labia are parted to the sides with clamps. To remove the Bartholin gland, it is better to make an incision along the vaginal mucosa directly through the excretory duct of the gland, and not through the labia majora. In the first case, healing is faster and less painful than in the second.

The vaginal mucosa is retracted medially, and the skin of the vestibule is retracted laterally in order to see the capsule of the gland. Its excretory duct may be visible if it is not changed by the previous inflammatory process and is not sclerotic.

Small scissors dissect thin adhesions between the wall of the cyst or abscess and the surrounding tissues. The cyst capsule is fixed with a clamp or other instrument. The capsule is raised to provide sufficient separation and visualization of the blood supplying vessels leading to the gland from the branches of the pudendal artery.

It is very important to remove the entire gland. Incomplete removal may cause the cyst or abscess to recur.

The last few thin adhesions to the gland are transected and the gland is removed.

After removal of the gland, bleeding from the wound often occurs.

It is necessary to perform careful hemostasis in the area of ​​the wound bottom. This often requires electrocoagulation or hemostatic sutures.

The bed of the gland should be sutured with separate sutures with 3/0 absorbable suture. Do not leave "dead" space.

A small drain is taken out of the wound and fixed with an interrupted suture with a 5/0 thread. This prevents it from falling out prematurely and at the same time makes it easy to remove if necessary.

The vaginal mucosa is connected to the skin of the vestibule with interrupted sutures with a Dexon 3/0 thread. The drainage is removed on the 3-4th day, when the discharge from it stops.

It is necessary to make a cultural study of the contents of the abscess. In this case, gonococci, streptococci, or other microflora are often found, which determines the appropriate antibiotic therapy.

On the third postoperative day, the patient is given warm sitz baths, a stool softener and a laxative.

Sex life is allowed after 4 weeks.

More on the topic EXCISION OF BARTHOLIN'S GLAND:

1. CLOSING OF DEFECTS AFTER WIDE LOCAL EXCISION OF VULVA SKIN
2. CORRECTION OF UTERUS DOUBLE BY HYSTEROSCOPIC EXCISION OF THE PARTITION WITH ELECTRIC LOOP
3. Diseases of the endocrine glands. Diseases of the endocrine part of the pancreas. Diabetes. Diseases of the thyroid gland. Thyroid tumors
4. EXCISION OF THE SKIN OF THE VULVA WITH TRANSPLANT OF A SPILLED SKIN FLAP

Removal of a Bartholin gland cyst is a full-fledged surgical intervention, which can be performed not only as planned, but also on an emergency basis. The disease of the genital organ causes inconvenience and pain not only with intimacy, but also with active sports, prolonged sitting or just walking in advanced cases.

From a physiological point of view, a cyst is a cavity that was formed in an unnatural way. In clinical practice, the neoplasm does not have a strictly defined size, ranging from a small pea to a real diameter. The main content is a liquid substance, which is the product of the work of the Bartholin gland itself.

Instead of being secreted in sufficient quantities during sexual contact, acting as a lubricant of natural origin, the duct of the output format is blocked. The biological fluid begins to accumulate instead of being released into the external environment and depart quite naturally.

Numerous reviews of women who have undergone surgery confirm the fact that pain is a companion of those affected by a cyst, even of a small size. Some short-sighted patients try to cope with the problem on their own, using lotions, compresses or other traditional medicine recipes. But getting rid of a cyst without involving a scalpel or a laser will not work out completely, it will only turn out to delay the inevitable, having endured an extensive inflammatory process.

Tips for patients

Not always a cavity with a problem fluid makes itself felt immediately after its inception. If the stage of suppuration has not yet come, then the girl may feel just a bump or unusual swelling in the intimate area. But since suppuration sometimes develops in a matter of days or even hours, it is better to immediately make an appointment with, and not wait for the worst development of events.

As soon as the immune system begins to weaken, this will indicate the start of a secondary infection. The cavity with biological material will begin to fill with purulent formations, raising the body temperature, and also signaling a sharp deterioration in the situation with other signs. When the suppuration mechanism starts, the woman will already encounter an abscess of the Bartholin gland, which in the medical classification indicates a complicated form of the disease.

The fact that the patient has a high chance of encountering a cyst in a short period of time is evidenced by several indirect factors. They are not one hundred percent precursors to the collection of secretions in the formed cavity, but they are called aspects of increased risk. The list includes the following diseases:

• infection with gonococci;
• urogenital candidiasis, which is popularly called simply thrush;
• ureaplasmosis;
• trichomoniasis;
• chlamydia.

Another item at risk is the weakened hygiene of the genital organs. It is this nuance that expands the circle of potential patients, since even teenage girls can become a victim of a cyst.

It is not necessary that after the discovery of even a large cyst, the victim will be redirected to the cancer center. As soon as it is confirmed that the neoplasm does not carry an oncological plaque, you do not have to worry. In the event of a planned surgical intervention, auxiliary tests and other examination options, if necessary, are additionally prescribed. Only after the doctor is convinced that the operation is the optimal solution, will the cyst be excised.

Moreover, different clinics offer their own package of basic services on a given issue. Today, most private medical centers use laser removal of an overgrown cavity that has an internal capsule for prolonged treatment. Radio wave treatment has proven to be successful, which is less traumatic than the classic scalpel procedure.

Ladies who have undergone manipulation note that modern technologies not only provide for less pain, but also guarantee a more aesthetic final result without loss of sensitivity of the genital organs. Also, innovative techniques guarantee a shortened postoperative period, which will appeal to those victims who cannot leave work for a long time.

The price of the operation directly depends on which excision format was chosen, as well as the type of anesthesia, the included preliminary examination, and consulting services for the period after removal. The cost also varies depending on the reputation of the chosen medical center and the qualifications of the gynecologist-surgeon.

Anxiety symptoms

Signs of the formation of a problem cavity are most clearly visible in the area of ​​\u200b\u200bthe gland itself. If the cyst is still small, then it does not cause significant discomfort even when having sex. But at the stage of suppuration, it is able to grow literally before our eyes.

The most characteristic symptoms that you should immediately contact your attending gynecologist are:

• swollen labia;
• rounded cone of any size;
• pain when moving or sitting for a long time.

Things get worse when the Bartholin gland becomes susceptible to the intervention of infection, which leads to the rapid development of bartholinitis. Such a turn becomes possible if pathogenic microorganisms that negatively affect the microflora of the vagina and external genital organs have entered the already diseased area.

Particularly dangerous:

• staphylococcus;
• gonococcus;
• coli.

When the cyst becomes infected, starting to collect pus, the labia swell several times, and when you feel an unaesthetically looking area, the victim experiences acute pain. Walking, even slowly, becomes almost impossible. Some patients note that in the supine position, everything becomes even worse.

The appearance of an abscess is accompanied by a sharp increase in temperature by several degrees simultaneously with a rapid increase in the cyst up to eight centimeters in diameter.

At the final stage, there is a high percentage probability of self-opening of the focus with accumulated secrets and purulent accumulations. Such an outcome threatens with possible infection of nearby organs and tissues, therefore, in emergency situations, the patient can even be hospitalized in an ambulance in intensive care.

When the operation is relevant

Often there are stories of women who suffer from chronic inflammation of the Bartholin's gland, experiencing periodic remissions. They use dubious means to neutralize pain in the intimate area, affecting the subsidence of inflammation. This leads to a decrease in the “ball”, but in fact this does not neutralize the cyst itself, provoking it to the accumulation of pus.

With constant inflammation of the glandular vestibule, which also covers the duct of the sex secretion generator, nonspecific conditionally pathogenic microorganisms enter the tissues and cells of the organ. Usually by this time the body loses its natural protection in the form of immunity, which is the key to a general deterioration in the resistance of a weakened organism.

In addition to a summary of the standard causes that prompt the gland to trigger a mechanism that negatively affects health, doctors also identify several atypical conditions. Among them, especially often, the primary source of the disease is trauma to the epidermis, which occurs due to:

• constant irritation of the skin;
• wearing tight underwear;
• epilation of the deep bikini zone.

Surgical termination of pregnancy is no less dangerous. It is often accompanied by classic bartholinitis, which is only then able to provoke a cyst on the other side of the gland.

Medicine knows cases when a cavity with a secret begins to interfere with normal life after a recent sexual intercourse, which turned out to be too traumatic for a woman.

To get rid of discomfort, as well as risks in the future to face more serious manifestations of abnormalities such as an abscess with pus, the representatives of the weaker sex are shown removing the cyst. The main indications for the procedure are:

• swelling of the labia minora;
• inflammation, which is already turning into suppuration;
• feeling of pressure on the external genitalia.

A distinctive advantage of the intervention is the ability to carry it out immediately, immediately on the day of treatment, if such a need is considered acute. Only a doctor on the spot after a thorough examination can say whether it is worth postponing the procedure for another day in order to have time to pass tests and conduct an allergic test for drugs from the anesthesia complex.

But if the cyst has already reached an impressive size, causing inconvenience and pain to the victim, then it is better to get ahead of opening the cavity in a natural way. The doctor removes the entire Bartholin's gland, simultaneously prescribing a complex of antibiotics.

Some clinics still offer visitors who are far from medicine to use the drainage system. But from a practical point of view, the scheme has more disadvantages than advantages. It implies frequent relapses, which entails repeated visits to the hospital, forcing the young lady to go through all the pain of healing again.

The meaning of drainage is based on blocking the duct with a special catheter, which is then dismantled only after complete healing with epithelialization.

Operations classification

There are several ways to get rid of a cyst. And often they both rely on local anesthesia. Only increased pain is a contraindication here, which automatically indicates the need to use general anesthesia. But for the most part, women prefer to endure rather than subject the cardiovascular system to an increased load during general anesthesia. The last word remains with .

Schematically, all approaches to getting rid of a cavity with a secret are divided into:

• marsupialization;
• husking.

But sometimes gentle workarounds just don't work. In the presence of serious complications, it will be more productive to remove the entire organ entirely. Together with the gland, the doctor removes the duct. Since the technique has several side effects, such as the lack of lubrication, it is practiced extremely rarely only in matters of saving the life of the patient.

Most often, patients manage marsupialization. The measure does an excellent job in situations where the victim is faced with regular relapses. Surgical intervention is based on the new formation of the duct along with the opening.

Marsupialization is necessary to further restore the patency of the excretory duct in order to effectively improve the functionality of the gland in the future. It is also aimed at eliminating possible post-inflammatory consequences that lead to the formation of abscesses in the cyst cavity.

When operating on a place that outwardly seems to be the most swollen, an incision is made on the mucosa. An identical action is carried out on the cyst. After that, the cavity is washed with special solutions, so that later the cyst shell is sewn to the area of ​​the labia mucosa. Such scrupulousness is the key to the construction of a new excretory duct.

Some gynecologists, under the guise of classical marsupialization, open the cyst without any additional measures. This means that the contents are cleaned, and then washing is prescribed. The epithelium simply does not have time to take on a protective film.

Experienced experts insist that this is not only harmful, but also almost always leads to a repetition of the picture: the duct will become blocked; the cyst will re-grow.

It is much more effective to install a catheter that contains a bubble inside. It is designed to stand for several weeks, which is quite enough to form a bypass channel with minimal chances of recurrence even after a few years.

For all of the above, local anesthesia is relevant. And if, at the end of the procedure, the woman feels normal, then she is not kept in the hospital, but sent home. A mandatory precaution here is the rejection of sexual contact for at least a month.

Much more difficult in terms of technology is the husking of a Bartholin's gland cyst. First, the surgeon makes an incision that is directed from the small lip. Making an incision in the reverse order is a rather dangerous undertaking, since in this part of the body the mucous membrane is especially sensitive. The entrance to the vagina, which is lined just with a mucous layer, quickly becomes thinner due to the negative impact of the disease. With the correct cut, the borders of the edges diverge by only a couple of millimeters.

1. The incised tissue is removed with the help of Pean's clamps and gauze swabs.
2. The contents are squeezed out carefully.
3. The risk of cyst rupture is controlled, which is easy to do when monitoring the situation, accurate cutting and maintaining the same pace of the operation.

If you reduce the set rate, then the likelihood of contamination of the open wound surface increases significantly. The final stage involves seams that are applied in the amount of two pieces.

It is extremely important to pay attention to the fact that during husking, the victim loses a lot of blood, so it is important to constantly monitor the situation. To reduce the load, it is enough just to bandage the branches that are weakening from hemorrhage. For venous wounds, tourniquets are used, which must completely cover the bed.

After applying the tourniquets, it will be necessary to remove the submerged sutures, and at the very end, the Peana clamps are removed. It remains to wait for the retraction of the epidermis so that the wound decreases.

The doctor fixes the incisions and the wound itself with vicryl.

You should prepare for a rather long rehabilitation period. In addition to the standard swelling of the vulva, you will have to come to terms with the fact that the external genital organs will be surrounded by a hematoma. There may be soreness and slight discharge.

In the future, you will need to take preventive measures to prevent a recurrence. We are talking about a general increase in immunity, as well as a redoubled effort thrown into personal hygiene.

Removal of the Bartholin's gland or extirpation is a radical surgical method that surgeons do not like to use because of its complexity and "bloodiness". But sometimes a complete excision of the gland becomes the only correct way out. Women who have had their Bartholin's gland removed must undergo a course of rehabilitation therapy. Its features are discussed in the article.

Postoperative period of Bartholin gland cyst

Inflammation of the Bartholin's gland associated with the formation of a cyst is treated only surgically. The operation is performed in the so-called "cold" period, when the stage of exacerbation of the inflammatory process passes. If the situation is not too neglected, gynecologists try to save the gland by performing marsupialization or husking of the cystic neoplasm itself. After surgery to remove a Bartholin gland cyst, the following measures are required:

• bacteriological culture of the purulent contents of the cyst, its study in the laboratory in order to determine the pathological microorganisms that need to be treated with antibiotics;
• therapy with antibacterial drugs;
• intake of vitamins and mineral complexes;
• visiting physiotherapy;
• daily replacement of gauze turundas in the wound, treatment of sutures with antibacterial solutions and healing ointments;
• taking medications that strengthen the immune system.

A woman should take care of herself after surgery, exclude sex, and avoid serious physical exertion. A new penetration of the infection into the ducts of the Bartholin glands, weakened by inflammation and disease, will lead to the formation of another abscess. Constant relapses of pathology deplete the female body, and can even lead to blood poisoning. To prevent this problem, the gynecologist recommends removing the Bartholin's gland completely. Excision of the organ requires careful actions of the surgeon, since there is a high risk of impaired hemostasis functions and the occurrence of severe bleeding.

Recovery after removal of the Bartholin's gland

If the complete removal of the Bartholin gland is performed, the postoperative period is delayed for a long time. Severe hematomas and edema appear in the vulva area, which disappear very slowly.

Recovery after removal of the Bartholin gland, as in the case of excision of the cyst, is associated with the elimination of pathogens that caused the pathology. Antibiotics are prescribed to achieve the following goals:

• reducing the risk of spread of infection throughout the body (for example, women with immunodeficiency or pregnant patients);
• elimination of symptoms of a systemic infection (fever, fever);
• the fight against pathogens of gonorrhea, chlamydia, methicillin-resistant Staphylococcus aureus, found during the study of pus from the cyst.

If a woman has a Bartholin gland removed, the postoperative period is associated with antibacterial treatment. The gynecologist prescribes the following groups of antibacterial drugs to such a patient to relieve inflammation:

• Azithromycin;
• Tetracycline;
• Ofloxacin.

In addition to antibiotics, a local treatment scheme is being developed using ointments and solutions that promote the speedy healing of a surgical wound (Levomekol, Vishnevsky, Ichthyol). The doctor takes into account that postoperative antibiotic therapy disrupts the vaginal microflora, and therefore prescribes multivitamin supplements with Linex to support and restore it.

How to restore the functions of the Bartholin's gland, which remained?

Usually, a gynecological surgeon removes only one gland affected by cysts, fistulas and scars. A healthy Bartholin's gland is preserved after the operation and continues to perform its functions "for two". The task of a woman is to protect the organ from the ingress of pathological bacilli. Antibiotic therapy helps a lot with this. Additionally, you need to work on strengthening immunity, changing the rules of nutrition, developing a diet. The following tips will tell you how to restore the Bartholin's gland and its functions.

1. Keep an eye on the hygiene of the external genital organs. Wash yourself at least 2 times a day, using for this purpose a solution of potassium permanganate, an antiseptic Tsiteal or a decoction of chamomile flowers. Cosmetics for intimate hygiene are also suitable for washing in the postoperative period.
2. Opt for loose-fitting underwear made from natural cotton rather than synthetic materials.
3. It is impossible to wear too tight trousers or jeans after the operation to remove one of the Bartholin glands.
4. Do not use sanitary napkins during the rehabilitation period, as they are an ideal breeding ground for pathological bacteria. If you can’t do without pads, change them as often as possible (ideally every 2-3 hours).
5. During menstruation, you can’t do without pads or tampons. A patient who has recently had a Bartholin's gland removed should change intimate hygiene products every 4 hours on the days of menstruation. It is recommended to wash before changing pads.
6. For the period of postoperative rehabilitation, it is better to refuse sexual intercourse and masturbation.

Complications can occur after Bartholin's gland surgery if the patient does not comply with the requirements for the care of sutures and the wound. Searching for an answer to the question "how to restore the Bartholin's gland after excision of a cyst", it is necessary to pay special attention to the recommendations for the treatment of a postoperative wound. Antiseptics in the form of brilliant green, Miramistin, Chlorhexidine or iodine will not allow the infection to penetrate inside. Thanks to such preparations, the remaining gland will not be exposed to the negative effects of pathogens.

A healthy lifestyle, moderate and proper nutrition, regular walks in the fresh air, playing sports - all this should become part of the daily life of a woman who wants to preserve the Bartholin gland, establish and activate its functions.