Laparoscopic removal of presacral cyst

A presacral cyst (also called pararectal) is a congenital neoplasm located in the tissue in the pararectal area. It is customary to distinguish several types of such cysts – teratomas, epidermoid and dermoid, teratocarcinomas.

They may not manifest themselves in any way for quite a long time, and a person may have absolutely no idea that there are such pathological formations in his body. The first manifestations are possible. only when the cyst begins to grow. In this case, the patient complains of:

• change in intestinal patency;
• painful sensations in the lower abdomen, tailbone and sacrum;
• purulent or mucous discharge from the rectum;
• tumor-like formations in the perineum;
• need to urinate frequently;
• frequent urge to defecate;
• Ribbon chair.

What is needed to make a diagnosis

Diagnostics of a presacral cyst includes:

• conversation with the patient, listening to his complaints and collecting anamnesis;
• visual general inspection;
• examination of the anus and perineum;
• digital rectal examination;
• examination of the rectum using an anoscope and sigmoidoscope;
• Ultrasound examination using a transvaginal/transrectal sensor;
• MRI, CT of the pelvic organs;
• fistulography, proctography.

This is a standard list of procedures used to diagnose this disease. in some cases, at the discretion of the attending physician, it can be expanded and supplemented with other research methods.

What is the treatment

When identifying a presacral formation, it is necessary to clarify its structure, location and connection with neighboring organs. For many cysts, elective complete removal is considered because of the potential for inflammation, complications, and diagnostic uncertainty. However, the decision and timing cannot be assigned equally to everyone without taking into account the overall condition, imaging results and operational risks. The tactics are determined by a specialized surgical team, explaining the purpose of the intervention, possible alternatives and observation conditions.

Technically, all operations to remove such cysts are quite difficult to perform, so such interventions can only be carried out in a specialized coloproctology hospital. Only an experienced surgeon is able to select the optimal type and extent of surgical intervention for a particular patient. In modern clinics, in recent years, preference has increasingly been given to laparoscopic techniques (the operation is performed through punctures on the anterior abdominal wall).

Laparoscopy in the treatment of pararectal cysts

The main advantages of laparoscopic methods, confirmed by many foreign and domestic studies, are considered to be:

• low trauma – the operation is almost bloodless;
• shorter duration;
• absence of large incisions on the perineum;
• lower risks of complications during surgery and during the rehabilitation period;
• no need for resection of the coccyx and creation of a stoma;
• minimizing the possibility of damage to the sphincter and rectum;
• shorter length of stay of the patient in the hospital;
• faster recovery after surgery – the patient can sit down and get up little by little the next day;
• discharge from hospital on the third day, reduction of the total period of incapacity for work;
• minimizing postoperative mortality;
• minimal probability of cyst recurrence;
• simultaneously with the operation to remove the presacral cyst, it is possible to perform other interventions on the pelvic and abdominal organs.

The choice of access to the presacral cyst depends on the anatomy of the formation and the safety of the operation. The perineal access itself does not mean that in the future only births by cesarean section are possible. Pregnancy planning and the method of delivery are discussed with the obstetrician and surgeon, taking into account the extent of the intervention, healing and obstetric indications. Preservation of pelvic organ function is one of the goals of treatment, but individual outcome cannot be guaranteed in advance.

What we offer patients

In our clinic, the following types of surgical interventions are possible to remove a presacral cyst:

• Operation using the HAL-RAR method:
  Thrombosed external node – thrombectomy according to indications;
  Longo operation in selected patients with internal prolapse;
• Transanal Doppler-controlled desarterization of internal haemorrhoids:
  stage 3-4 operation Haemorrhoidectomy according to Milligan-Morgan using the Liga Sure device.

In addition, we treat the following pathologies:

• Sharp crack;
• Chronic fissure;
• Pararectal fistulas;
• Epithelial coccygeal ducts;
• Presacral cyst – laparoscopic removal of a presacral cyst;
• Prolapse of the rectal mucosa with stage 4 haemorrhoids – Longo operation (stapled haemorrhoidopexy.)

In all operations, we use an epidural catheter for postoperative anesthesia. Spinal-epidural anesthesia is performed with placement of an epidural block. Thanks to this, the patient does not feel any pain during the treatment.

Recovery after laparoscopic surgery

On the patient’s body after laparoscopic intervention, up to 4 small incisions remain on the abdomen. Their length is from 5 to 10 cm. The operated patient can already sit up in bed on the first day, eat liquid meals, and after a few days, if he feels normal, he is allowed to leave the hospital.

After removal of a pararectal cyst laparoscopically, regular monitoring by a proctologist is required. The patient should come for examination and ultrasound after 1, 3, 6 months. The operated person becomes fully able to work 12–21 days after the operation.

The advantages of visiting our clinic include:

• individual approach to each patient;
• compliance with all rules of disinfection and sterilization;
• comfortable environment, friendly service;
• affordable cost of diagnostic and therapeutic procedures.

The sooner you seek professional help, the sooner an accurate diagnosis will be made and treatment will begin. Don’t waste precious time – sign up for a consultation with us!