Excision Of Sacrococcygeal Teratoma Research Articles

Vertical wound closure following sacrococcygeal teratoma excision: an approachable aesthetic solution

BackgroundSacrococcygeal teratoma is a rare tumour, usually presenting in the neonatal period. The benign nature of most tumours and the high survival rates would emphasise on the importance of both cosmetic and functional outcomes.We report on our extended experience with more cases concentrating on the aesthetic outcome of vertical wound closure following excision of large irregular sacrococcygeal tumours.The study included primary cases of sacrococcygeal teratoma who were referred to our surgical team for excision. Cases of presacral tumours associated with anorectal anomalies and sacral bony defects (Currarino triad) were excluded. In all cases, we planned for a vertical midline wound closure after tumour excision. The aesthetic outcomes are evaluated concerning the vertical midline scar, buttock’s contour, and position of the anus.ResultsIn addition to twelve previously reported cases (during the period 2011 through 2016), we included another ten new consecutive cases operated during the period 2017 through 2021. Collectively, the study included 22 cases of sacrococcygeal teratoma that underwent vertical perineal wound closure after excision of the tumour. In 13 cases (those with relatively small or medium-sized tumours), the perineal wound was perfectly closed in the midline (well-hidden vertical scar in the natal cleft). For the rest of the cases (9 cases with large and/or irregular sacrococcygeal tumours), some modification was applied on the vertical linear mid-line skin closure to accommodate for skin redundancy and irregularity at the lower end of the wound, usually ending with an ‘inverted-Y’ skin closureConclusionVertical wound closure was always feasible after excision of sacrococcygeal teratomas. Even with large and irregular tumours, the vertical scar was perfectly or partially hidden within the natal cleft. Usually, there was adequate buttock development with minimal disturbance to the normal anal location within the perineum.

Review of laparoscopic median sacral artery ligation in sacrococcygeal teratoma

Sacrococcygeal teratoma is one of the commonest neonatal tumour usually presenting as a large exophytic sacral mass in utero and at birth. It is a highly vascular tumour and the main blood vessel supplying it is median sacral artery (MSA) which can cause torrential haemorrhage during excision. Many surgeons advocate ligation of MSA prior to tumour excision. Traditionally it was done by laparotomy or by posterior midline approach prior to tumour excision. Laparoscopic ligation of MSA in neonates prior to tumour excision was performed using a ultrasonic dissector to expose the area. Using endoclips the artery was ligated, following which the tumors were resected. The procedures were completed with minimal blood loss and successul excision of the tumor was achieved in our patients. Haemorrhage is the principal concern during sacrococcygeal teratoma excision. This risk can be safely minimized by laparoscopically ligating the median sacral artery which is the principal feeding vessel for the tumor.

Sacrococcygeal teratoma excision

Background: The chevron incision has been the standard approach for sacrococcygeal teratoma (SCT) excision. Here, we are reporting our experience of shifting to the vertical posterior sagittal approach. Patients and methods: During the period 2011 through 2016, we operated on 17 (16 female and one male) cases of SCT. Their age at presentation ranged from day 1 to 26 months (mean=4.8 months, median=2 months). The chevron incision was used in five, whereas the vertical posterior sagittal approach was used in 12 patients. Results: In this series, we had one case of perioperative mortality, in addition to another case of perineal wound disruption (in the group of vertical wound closure), which was managed conservatively (to heal by secondary intention) with a very satisfactory hidden scar at 6-month follow-up. Overall, we did not find the vertical approach to add any extra limitations to the surgical exposure or dissection; meanwhile, it provided a well-recognized cosmetic advantage. Conclusion: The vertical posterior sagittal approach for excision of SCT is both feasible and advantageous in terms of the cosmetic outcome. It provides a well-hidden scar in the natal cleft and preserves normal contouring of the buttocks. Keywords: buttock, cosmesis, posterior sagittal, reconstruction, sacrococcygeal teratoma

Urological and intestinal functional outcomes of sacrococcygeal teratoma following surgery

Surgery for sacrococcygeal teratoma (SCT) in neonatal period may result in functional problems of micturation and defecation caused by pelvic nerve dam - age. We aimed to evaluate long term outcome of patients with SCT in terms of bladder dynamics. To evaluate the postoperative urological outcome related with SCT excision, urodynamic study, ultrasonographic and scintigraphic ex - aminations were performed. The families are asked about the micturition and defecation paterns. Twenty-one patients (eight male, thirteen female) underwent SCT excision between 2006 and 2013 and seventeen (six male, eleven female) are regarded eligible for long term evaluation. Incidence of constipation was 9.4%, encopresis 9.4% and urinary incontinence 4.7%. Two patients had a his - tory of urinary tract infection without reflux on voiding cystourethrography or renal scarring on renal cortical scintigraphy. Three patients had increased post - voiding residual urine of 25 to 35 mL while four had increased bladder capacity. Meticulous surgical technique for excision of SCT in newborns may avoid sig - nificant urinary and defecation problems subsequently.

The long-term psychosocial outcomes following excision of sacrococcygeal teratoma: a national study

ObjectiveThe overall effect of the reported long-term sequelae following sacrococcygeal teratoma (SCT) excision on the psychosocial and sexual development has not been addressed appropriately in the literature. The aim of...

Long-term Functional Outcome of Sacrococcygeal Teratoma in a UK Regional Center (1993 to 2006)

Sacrococcygeal teratoma (SCT) is the commonest neonatal neoplasm. Its long-term effects are important in prenatal counseling and the delivery of an appropriate postoperative plan. To determine the long-term functional outcome after SCT excision in a UK regional center. Follow-up data for all patients with a SCT excised at the John Radcliffe Hospital in Oxford was collected retrospectively from notes and prospectively in clinic visits. Clinical evidence of bowel or bladder impairment, mortality. Over a 14-year period, 18 patients had a histologic diagnosis of SCT. Nine patients (50%) were born, 7 (39%) were terminated, and 2 (11%) were stillbirths. Of the 9 patients who had SCT resection, 4 (44%) were antenatally diagnosed. There were no perioperative deaths and alpha-fetoprotein levels normalized by 6 to 12 months after tumor resection. Median follow-up of patients was 30 months (range: 6 to 132 mo) with 1 patient lost to follow-up at 6 months, although he was asymptomatic at the time. Three patients developed urologic complications (2 within 1 year of tumor resection), including 2 patients with neurogenic bladder dysfunction and 1 patient with detrusor sphincter dyssynergia. Approximately one-third of patients will develop major urologic complications after resection of SCT. Routine ultrasonography in the first postoperative year after tumor resection may help to identify patients with neuropathic bladder at the early stage and predict late complications. Parents need to be aware of this potential long-term complication during prenatal counseling and the need for regular long-term follow-up with the pediatric surgical team.

Sacrococcygeal teratoma: Clinical characteristics and long-term outcome in Nigerian children

The excision of sacrococcygeal teratoma (SCT) may be associated with significant long-term morbidity for the child. We reviewed our experience with SCT in a tertiary health care facility in a developing country with particular interest on the long-term sequelae. Between January 1990 and May 2008 inclusive, 38 consecutive children with the diagnosis of SCT were identified from the operation register and the Cancer Registry of the Jos University Teaching Hospital. Their clinical presentation, investigation, operative findings, histology report, and outcome were recorded and analyzed. The long-term follow-up of some of the patients were also recorded and analyzed. There were 31 females and 7 males. Twenty-three patients presented during the neonatal period with a median age at presentation of 7 days (range 1-18 days) and a median weight at presentation of 2.8 kg (range 2.0-3.6kg), 10 presented between 1 month and 12 months, while 5 were older than 1 year at presentation. Most of the patients had significantly external tumors. Excision of the tumor was mainly by the sacral route, four had abdominal-sacral excision. Histology was mainly benign; four were malignant at presentation. Four children with malignant disease had chemotherapy in addition to excision of the tumor. Eight had immediate post-operative wound-related complications while three children died, two of the deaths were related to anesthesia, while one died of colostomy complications. Twenty-one (60%) were followed up for a median duration of 6 years (range 1 month-8 years). Two (9.5%) had recurrent disease after primary excision; five (23.8%) had some degree of functional impairment at the follow-up. While SCT is usually benign, recurrence, malignant transformations in patients who present late and long-term functional sequelae are problems that must be tackled by the care givers. A multi-center study may be necessary to characterize this disease in developing countries and assess the long-term functional sequelae in survivors.

Malignant benign neonatal sacrococcygeal teratoma

Thirty-six patients with benign neonatal sacrococcygeal teratoma (SCT) were treated in our medical center from 1972 to 1990. Mean gestational age was 38.6 ± 3.3 weeks with a mean birth weight of 3,484.0 ± 938.5 g. Twenty-nine patients (89%) were females. The majority of the tumors (75%) contained cystic components and 96% were Altman classification I and II. The initial surgical removal of the SCT (including the coccyx) was carried out during the first 7 days of life. Six patients (22%) developed recurrence of the tumor. Three were benign and reappeared locally after 12 ± 3 months and were reexcised. The mean serum α-fetoprotein level in this group was 13 ± 1 g/L. The malignant recurrence (all originally reported as being mature benign SCT) appeared at 20.3 ± 1.5 months and had markedly elevated serum α-fetoprotein levels (7,320 ± 4,630 μg/L). All the patients in this group had multimodal therapy including complete excision of the recurrent tumor. We conclude that SCT, although histologically benign, has an alarming potential to recur either as a benign or malignant tumor during the first 2 years of life. Close follow-up for at least 3 years (frequent examination, serum α-fetoprotein, and diagnostic imaging) is recommended for all patients who had undergone excision of SCT in the newborn period.