Benign retrorectal tumours: Contribution of laparoscopic approach

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.