Benign retrorectal tumours: Contribution of laparoscopic approach

Victor J. Ovejero-Gomez, M. V. Bermudez-Garcia, L. Martin-Cuesta, A. Güezmes, J. Villalba, A. Ingelmo, J. M. Bajo-Arenas

Department of Gynaecology, Hospital Sierrallana, Cantabria, Spain.
Department of Pathology, Hospital Sierrallana, Cantabria, Spain.
Department of Radiology, Hospital Sierrallana, Cantabria, Spain.
Department of Surgery, Hospital Sierrallana, Cantabria, Spain.

DOI: 10.4236/crcm.2013.27111                

Abstract

Introduction: Presacral tumours are extremely rare entities as the asymptomatic retrorectal mass, although its clinical presentation includes infectious complications and signs of malignant degeneration. Magnetic resonance imaging is the most efficient imaging study for its diagnosis. The treatment of choice is complete surgical excision and traditional approaches are mainly through abdominal, posterior and perineal approach, depending on anatomical characteristics of the lesion. Laparoscopic excision of these retrorectal lesions has been reported in a few cases. Patients and methods: We report two cases of 38 and 24-year-old women who complained of anorectal symptoms and were diagnosed as retrorectal tumour by imaging studies. One of them was infected. Both cases were resected by means of laparoscopic techniques. There was no surgical complication and they were discharged on the 3^rd and 4^th postoperative day, respectively. Histopathologic findings revealed benign cystic teratoma in both cases. A follow-up after 36 months showed no recurrence. Our surgical endoscopic technique and a brief review of perioperative cares are presented and discussed. Discussion: Laparoscopic excision could be indicated in selected retrorectal tumours and a great surgeon’s resolve is always required. A meticulous dissection must be performed in order to identify and preserve vital structures. It’s only absolute contraindications seemed to be the suspicion of malignancy and operative inexperience. Conclusions: The complete laparoscopic removal of presacral lesions is a responsible surgical procedure which offers advantages from the sanitary and aesthetic point of view. This new endoscopic indication could be considered probably as a better technique than open approach in selected patients.

Keywords

Retrorectal; Tumour; Laparoscopy; Surgical Technique

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Ghosh, J., Eglinton, T., Frizelle, F.A. and Watson, A.J. (2007) Presacral tumours in adults. Surgeon, 5, 31-38. http://dx.doi.org/10.1016/S1479-666X(07)80109-0
[2]	Messick, C.A., Londono, J.M. and Hull, T. (2013) Presacral tumors: How do they compare in pediatric and adult patients? Pol Przegl Chir, 85, 253-261.
[3]	Pappalardo, G., Frattaroli, F.M., Casciani, E., Moles, N., Mascagni, D., Spoletini, D., et al. (2009) Retrorectal tumors: The choice of surgical approach based on a new classification. The American Surgeon, 75, 240-248.
[4]	Coco, C., Manno, A., Mattana, C., Verbo, A., Sermoneta, D., Franceschini, G., et al. (2008) Congenital tumors of the retrorectal space in the adult: Report of two cases and review of the literature. Tumori, 94, 602-607.
[5]	Vega-Menéndez, D., Quintans-Rodríguez, A., HernándezGranados, P., Nevado-Santos, M., García-Sabrido, J.L. and Rueda-Orgaz, J.A. (2008) Hamartomas quísticos retrorrectales. Cirugía Espanola, 83, 53-60. http://dx.doi.org/10.1016/S0009-739X(08)70506-2
[6]	Hobson, K.G., Ghaemmaghami, V., Roe, J.P., Goodnight, J.E. and Khatri, V.P. (2005) Tumors of the retrorectal space. Diseases of the Colon & Rectum, 48, 1964-1974. http://dx.doi.org/10.1007/s10350-005-0122-9
[7]	Maruyama, A., Murabayashi, K., Hayashi, M., et al. (1998) Adenocarcinoma arising in a tailgut cyst: Report of a case. Surgery Today, 28, 1319-1322. http://dx.doi.org/10.1007/BF02482826
[8]	Szyllo, K. and Lesnik, N. (2013) Sacrococcygeal teratoma— Case report and review of the literature. American Journal of Case Reports, 14, 1-5.
[9]	Kohler, C., Kühne-Heid, R., Klemm, P., Tozzi, R. and Schneider, A. (2003) Resection of presacral ganglioneurofibroma by laparoscopy. Surgical Endoscopy and Other Interventional Techniques, 17, 1499.
[10]	Lev-Chelouche, D., Gutman, M., Goldman, G., Even-Sapir, E., Meller, I., Issakov, J., et al. (2003) Presacral tumors: A practical classification and treatment of a unique and heterogeneous group of diseases. Surgery, 133, 473-478. http://dx.doi.org/10.1067/msy.2003.118
[11]	Pescatori, M., Brusciano, L., Binda, G.A. and Serventi, A. (2005) A novel approach for perirrectal tumours: The perianal intersphinteric escisión. International Journal of Colorectal Disease, 20, 72-75. http://dx.doi.org/10.1007/s00384-004-0623-3
[12]	Chen, Y., Xu, H., Li, Y., Li, J., Wang, D., Yuan, J. and Liang, Z. (2008) Laparoscopic resection of presacral teratomas. Journal of Minimally Invasive Gynecology, 15, 649-651. http://dx.doi.org/10.1016/j.jmig.2008.06.011
[13]	Palanivelu, C., Rangarajan, M., Senthilkumar, R., Madankumar, M.V. and Annapoorni, S. (2008) Laparoscopic and perineal escision of an infected “dumb-bell” shaped retrorectal epidermoid cyst. Journal of Laparoendoscopic & Advanced Surgical Techniques, 18, 88-92. http://dx.doi.org/10.1089/lap.2007.0010
[14]	Paul, P.G., Pravinkumar, T. and Sheetal, B. (2012) Sacrococcygeal neurofibroma: Rare cause for chronic pelvic pain. Journal of Minimally Invasive Gynecology, 19, 517-520.