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Surgical options consist primarily of either an anterior transabdominal or a posterior transsacral approaches. The main goal of surgery should be to safely disconnect the cyst from subarachnoid space to prevent further enlargement, thereby reducing the compression of nearby structures.   The anterior transabdominal approach could be performed via laparoscopic or open trans-abdominal/laparotomy, usually it  is not considered as the first 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 is usually no need to decompress or remove the cyst. Instead, treatment via a posterior approach to interrupt the fistula is sufficient, and the cyst will gradually and spontaneously resolve(citas).