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The anterior transabdominal approach may be performed via laparoscopic or open trans-abdominal/laparotomy, usually it is not considered as the first surgical option unless decompression and rapid removal of the cyst wall is required. Extreme caution must be taken when extensive resection of the cyst wall is performed since adherence to surrounding visceral structures can lead to complications such as fecal or vesical fistulas.\cite{16793455}
Several reports have stressed the advantages of the posterior transsacral
technique, since there technique. (citas) This anatomical approach was first described by Adson et al. in 1938 and even today it is
usually no considered as a relatively easy and safe technique. This approach allows ligation of the stalk of the ASM without the need to decompress or remove the
cyst. Instead, treatment via a posterior cyst, decreasing the risk of further infections. Other advantages of this approach
are control of the nerve roots, filum terminale and dura matter.
We present a case of a giant anterior sacral meningocele with some interesting nuances. Although the diagnosis sometimes can be very challenging, this phatology should always be kept in mind in order to
interrupt avoid erroneous diagnoses that may expose
the
fistula patient to unnecessary invasive procedures. Imaging is
sufficient, and critical, but a careful obtained medical history can reveal important clues. Surgery is generally advised, especially if there is compression on pelvic structures. Multiple surgical
approaches are available. Nonetheless, the
cyst will gradually posterior approach remains
the treatment of choice for most lesions. Each approach
must be carefully analyzed and
spontaneously resolve(citas). the choise should be made on the basis of the specific surgical goals pretended for each case.