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How Is Marsupialization Done?

Reviewed on 11/10/2020

Pilonidal Cyst
Pilonidal cyst: a cyst that contains hair and skin debris near or on the cleft of the buttocks; also known as jeep driver's disease

Marsupialization is a surgical procedure to treat cysts (an abnormal, noncancerous growth with fluid accumulation), prevent infection, and prevent a recurrence. It is performed to treat cysts occurring in various parts of the body, such as around the vagina, the jaw, or the lower back. The cyst is surgically opened and drained, and the edges are sutured together to form a permanently open pouch (marsupialization) that is around 6 mm in size, allowing the fluid to drain easily.

Marsupialization is a short procedure and takes around 15 minutes to complete. It is performed under local or general anesthesia. The surgical wound usually heals in 1-2 weeks.

What is a cyst?

A cyst has a sac-like structure and is an abnormal, benign (noncancerous) growth. Sometimes, they may be felt as an abnormal or new lump or bump. Cysts usually are filled with fluid, air, or semisolid substances like tissue debris or other materials and covered by a capsule. If a cyst gets infected, it gets filled with pus. Cysts vary in size and are painless. They are usually asymptomatic initially. Larger cysts can cause discomfort. Infected cysts can cause pain and significant discomfort. Cysts are usually caused due to obstructions to the outflow of fluid due to injury, infections, tumors, chronic inflammation, wear, and tear. Poor hygiene practices increase the risk of cyst formation.

Types of cysts:

There are over hundreds of different types of cysts that can arise anywhere in the body or at any age. Some common types of cysts for which marsupialization is done include:

  • Bartholin cysts: They arise from the Bartholin glands that lubricate the vagina.
  • Pilonidal cysts: Cysts that occur on the lower back, near the cleft of the buttocks.
  • Epidermal cysts: Small cysts in the skin.
  • Dentigerous cyst: A cyst occurring in the jaw.
  • Lacrimal cyst: This arises from the lacrimal or tears glands in the eyes.
  • Dermoid cysts: Benign (noncancerous) cysts that contain a mix of different tissue types.
  • Baker cyst: This is also called a popliteal cyst and occurs behind the knee.

After the procedure

Early, asymptomatic cysts usually do not require any treatment. Some cysts may resolve with conservative remedies but they can recur. Treatment of cysts that don’t resolve with conservative measures, require surgical drainage. Surgical drainage with marsupialization is done to prevent a recurrence. If the cyst is infected, the patient would first be treated with antibiotics to resolve the infection before proceeding with surgical drainage and marsupialization. The procedure is done under general or local anesthesia.

During surgical drainage, the doctor makes a small incision over the cyst and drains the fluid. During marsupialization, the doctor places sutures (stitches) on either side of the incision, creating a small permanent opening of around 6 mm. A thin tube (catheter) may be placed for a few days to drain the fluid completely and further help prevent a recurrence.

After the procedure:

Patients are usually discharged the same day after the procedure once they recover from anesthesia. Patients can resume their daily activities the next day. Patients may resume specific activities like exercise, sports, and sexual intercourse after consulting with the doctor. It is advised that patients keep the surgical wound clean and dry and follow specific aftercare instructions given by the doctor. Antibiotics and painkillers are usually prescribed after the procedure to prevent infection and reduce pain, respectively. Complete wound healing may take 1-2 weeks.

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References
https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1743-6109.2008.00832.x

https://www.sciencedirect.com/topics/medicine-and-dentistry/marsupialization

https://www.medscape.com/answers/80260-55720/what-is-marsupialization-of-a-bartholin-abscess

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