The Laparoscopic Excisions of the Tailgut Cysts in Retrorectal Space

Sang Woo Lim, MD PhD, Jung Wook Huh, MD, Young Jin Kim Kim, MD PhD, Hyeoung Rok Kim, MD PhD. Department of Colon and Rectal Surgery, Chonnam National University Hwasun Hospital, Gwangju, Korea

INTRODUCTION
Tailgut cysts, or retrorectal cystic hamartomas are rare congental developemental lesions , and the location is mostly retrorectal space, and more common in woman.
We present a retrorectal tailgut cyst which is managed by the laparoscopic approach.
METHODS AND PROCEDURES:
A-36-year-old woman presented for the incidentally detected retrorectal tumor during the evaluation for a gallbladder polyp. She had the Cesarian section two times on past history. Physical examination and laboratory studies were unremarkable. The tumor marker CA 19-9 study was 42.52 U/ml. A CT with contrast and the pelvic MRI revealed a 3.9 x 3.3 cm well defined homogenous cystic mass in right the presacral area, and a 2.5x 1.5 cm cystic mass in the precoccygeal space. The patient underwent a laparoscopic exploration with a preoperative diagnosis of tailgut cyst. The mesorectal dissection from sacral promontory is continued along up to the level of puborectalis sling and the levator ani muscles. The exicisions were macroscopically complete with negative margins, and the rectum was not injured. The operation time was 90 minutes including 30 minutes of subsequent laparoscopic cholecystectomy with no additional trocars.

RESULTS
The surgical specimens were consisted of two fibrofatty tissues, unilocular cystic masses. The final pathologic diagnoses were tailgut cysts with no evidence of malignancy. The postoperative recovery was uneventful, and the patient was discharged after 3 days.

CONCLUSION
Surgical resection is recommended to manage of the retrorectal tailgut cyst for a definite diagnosis and rule out malignancy, and the laparoscopic approach is a feasible and safe option.