Laparoscopic resection of large retrorectal developmental cysts in adults: Single-centre experiences of 20 cases

CONTEXT: Retrorectal tumours are rare with developmental cysts being the most common type. Conventionally, large retrorectal developmental cysts (RRDCs) require the combined transabdomino-sacrococcygeal approach. AIMS: This study aims to investigate the surgical outcomes of the laparoscopic approach for large RRDCs. SETTINGS AND DESIGN: A retrospective case series analysis. SUBJECTS AND METHODS: Data of patients with RRDCs of 10 cm or larger in diameter who underwent the laparoscopic surgery between 2012 and 2017 at our tertiary centre were retrospectively analyzed. STATISTICAL ANALYSIS USED: Results are presented as median values or mean ± standard deviation for continuous variables and numbers (percentages) for categorical variables. RESULTS: Twenty consecutive cases were identified (19 females; median age, 36 years). Average tumour size was 10.9 ± 1.1 cm. Cephalic ends of lesions ranged from S1/2 junction to S4 level. Caudally, 18 cysts extended to the sacrococcygeal hypodermis. Seventeen patients underwent the pure laparoscopy; three patients received a combined laparoscopic-posterior approach. The operating time was 167.1 ± 57.3 min for the pure laparoscopic group and 212.0 ± 24.5 min for the combined group. The intraoperative haemorrhage was 68.2 ± 49.7 and 66.7 ± 28.9 (mL), respectively. Post-operative complications included one trocar site hernia, one wound infection and one delayed rectal wall perforation. The median post-operative hospital stay was 7 days. With a median follow-up period of 36 months, 1 lesions recurred. CONCLUSIONS: The laparoscopic approach can provide a feasible and effective alternative for large RRDCs, with advantages of the minimally invasive surgery. For lesions with ultra-low caudal ends, especially those closely clinging to the rectum, a combined posterior approach is still necessary.