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Vulva and Introitus

Biopsy of the Vulva

Excision of Urethral Caruncle

Bartholin's Gland Cyst Marsupialization

Excision of Vulvar Skin, with Split-Thickness Skin Graft

Bartholin's Gland Excision

Vaginal Outlet
Stenosis Repair

Closure of Wide Local Excision of the Vulva

Wide Local Excision
of the Vulva, With Primary Closure or Z-plasty Flap

Alcohol Injection
of the Vulva

Cortisone Injection
of the Vulva

Merring Operation

Simple Vulvectomy

Excision of the
Vulva by the Loop Electrical Excision Procedure (LEEP)

Excision of
Vestibular Adenitis

Release of Labial Fusion


Excision Of Hypertrophied Clitoris

Bartholin's Gland Excision

Excision of the Bartholin's gland has been called the "bloodiest little operation in gynecology." It is indicated for persistent and recurrent Bartholin's gland abscess and cyst. The key to successful excision is hemostatic control of the copious blood supply to the gland.

The purpose of the operation is to remove the entire Bartholin's gland.

Physiologic Changes. Bilateral removal of Bartholin's gland eliminates the secretion of fluid from the gland that is useful as a vaginal lubricant. In the well-estrogenized vagina, however, this is generally not a clinical problem.

Points of Caution. Meticulous hemostasis is essential. The branches of the pudendal artery are frequently lacerated during excision of the Bartholin's gland. They must be carefully identified, clamped, and tied, or postoperative vulvar hematoma will result.


The patient is placed in the dorsal lithotomy position, and the perineum is prepped and draped.

Careful rectovaginal examination is performed to outline the entire Bartholin's gland cyst or abscess.

To control bleeding, it is essential that the surgeon understand the vascular supply to the labia and vagina.


The labia are retracted laterally with several Allis clamps. For resection of the Bartholin's gland, it is preferable to make the incision over the vaginal mucosa, directly over the meatus of the gland, rather than over the labia majora. Healing in this area appears to be faster and less painful for the patient than does healing to an incision in the skin of the labia.

The vaginal mucosa is retracted medially, and the skin of the introitus is retracted laterally to expose the wall of the gland. Its meatus may be seen if not distorted by old infection and scarring.

A small Metzenbaum scissors is used to lyse the filmy adhesions between the wall of the abscess or cyst and the overlying vaginal mucosa and subcutaneous tissue of the labia majora. Either forceps or an Allis clamp is placed on the wall of the cyst. The wall is retracted to allow adequate dissection and identification of the blood supply to the gland from branches of the pudendal artery.


It is important to excise the entire gland. Incomplete removal may lead to a recurrence of the cyst or abscess.

The last few filmy adhesions to the gland are incised with Metzenbaum scissors, and the gland is removed.

After removal of the gland, there is frequently bleeding from the wound.

Care must be taken that meticulous hemostasis is carried out throughout the bed of the gland. Hemostasis frequently requires electrocoagulation and suture ligation.

The bed of the gland should be closed with interrupted 3-0 absorbable suture to eliminate dead space.

A small closed suction drain is inserted into the wound and sutured into place with interrupted 5-0 absorbable suture. This prevents the drain from being prematurely dislodged but allows for easy removal.

The closure of the vaginal mucosa to the skin of the introitus is completed with interrupted 3-0 Dexon suture.

The closed suction drain is removed on the third or fourth day when there is no further drainage.

Cultures of the abscess should be made. Frequently, gonococci, streptococci, or other organisms are found; therefore, preoperative antibiotics are used in most cases.

On the third postoperative day, the patient is placed on a regimen of hot sitz baths and is given a stool softener and laxative.

Sexual intercourse can usually be resumed in 4 weeks.


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