Marsupialization

MARSUPIALIZATION, a procedure used in the surgical treatment of cysts of the abdominal or thoracic cavities, and sometimes of organs, in cases where the cyst is not removed, which consists in suturing the opened wall of the cyst into the external wound. M. is performed

depending on the contents of the cyst (serous, parasitic, purulent). In the first case, the cyst, having been preliminarily protected with tampons against the leakage of its contents into the free abdominal or thoracic cavity, is punctured, and its contents are emptied. The wall of the cyst is then incised, its excess part is removed, and the remaining part, fused with surrounding organs, is sutured into the wound of the abdominal or thoracic wall, if possible hermetically isolating the free cavity from infection during subsequent open treatment. In the second case, the cyst is not emptied, but its wall is sutured into the external wound, and only 7-10 days after a firm adhesion has formed is the cyst emptied and tamponed. Since the cavity of the cyst is sometimes very large and heals extremely slowly under tampons, and fistulae sometimes remain, M. is currently resorted to less and less frequently. Formerly, M. was widely used for ovarian cysts, broad ligament cysts, and also for echinococcal cysts. The latter are nowadays operated on exclusively by the closed method (see Echinococcus). M. is now performed only in cases where the cyst presents great difficulties and dangers for removal due to its position or, being fused with neighboring organs, cannot be removed without damaging them. This applies to cysts of the abdominal and thoracic cavities and even of the brain. In the latter, the cyst wall is sutured to the dura mater.