Combined laparoscopic and perineal approach for the management of recurrent tailgut cyst

Abstract

Tailgut cyst is an uncommon developmental anomaly arising from the embryonic hindgut in the retrorectal space. The patient frequently is asymptomatic or has vague perineal complaints that pose a diagnostic dilemma. Moreover, the patient is often misdiagnosed and therefore mismanaged. MRI is the investigation of choice for diagnosis. After the diagnosis is established, complete surgical excision is required to alleviate patient discomfort and to prevent complications such as infection, malignant transformation, and recurrence. Proper clinical examination and imaging not only establish the accurate diagnosis but also help in determining the best surgical approach for the patient (anterior abdominal, posterior sacral perineal, or combined approach). We hereby report a case of recurrent tailgut cyst managed with a combined anterior laparoscopic and perineal approach.

Epidemiology, diagnostic approach and therapeutic management of tailgut cysts: A systematic review

“…Concerning the diagnostic approach of TGCs, patient’s examination combined with imaging techniques contributes to the localization of the primary cystic lesion. DRE usually detects a palpable mass of the retrorectal region, whereas physical examination is otherwise uneventful 35 . However, in our study, DRE managed to detect a palpable mass only in 38.5% of included cases, suggesting that a normal DRE should not exclude the possibility of a TGC in the presacral region.…”

“…DRE usually detects a palpable mass of the retrorectal region, whereas physical examination is otherwise uneventful. 35 However, in our study, DRE managed to detect a palpable mass only in 38.5% of included cases, suggesting that a normal DRE should not exclude the possibility of a TGC in the presacral region. Additionally, transrectal US and endoscopy are capable of recognizing a primary cystic lesion, whereas CT usually demonstrates a well-circumscribed hypodense lesion without calcification and can identify malignant transformation of TGCs as well.…”

“…The mainstay of TGC treatment consists of complete resection of the cyst, either with open surgery, laparoscopically or robotically 53,54 . Despite the benign nature of this entity, a complete resection is required even in asymptomatic patients, due to the increased risk of complications, such as malignant degeneration and infection 35,55 . Due to the non‐specific imaging findings of TGCs and their increased incidence of malignant transformation, complete surgical resection comprises the optimal therapeutic approach, whereas a surveillance strategy alone should not be recommended.…”

“…53,54 Despite the benign nature of this entity, a complete resection is required even in asymptomatic patients, due to the increased risk of complications, such as malignant degeneration and infection. 35,55 Due to the non-specific imaging findings of TGCs and their increased incidence of malignant transformation, complete surgical resection comprises the optimal therapeutic approach, whereas a surveillance strategy alone should not be recommended. Despite the absence of specific guidelines concerning the managements of TGCs, the appropriate surgical approach mainly depends on the morphology, location and size of the cysts and should be determined by their relation with the surrounding structures.…”

Tailgut Cysts with Malignant Transformation: Features, Diagnosis, and Treatment

“…Proper clinical examination not only establishes an accurate diagnosis, but also helps determine the best surgical approach for patients with tailgut cysts [61]. Although successful ultrasound-guided fine needle aspiration has been reported, the risk of malignant cell bleeding, infection, and spread to the abdominal cavity remains high, which increases the difficulty of subsequent surgical resection [24,62].…”