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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.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.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.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.