Transsacral approach for fistula after restorative proctocolectomy: A case report

A 43-year-old male patient with analgesia and prulent discharge from the perianus was admitted to our hospital. He underwent restorative proctocolectomy with covering ileostomy for ulcerative colitis 52 months ago, and ileostomy was closed 4 months later. Perineal abscess appeared one year after ileostomy closure. Transanal and transperineal operation was performed twice for perianal fistula, but fistula recurred one month after each operation. Fistulography combined with pouchography showed a complicated fistula around the pouch originating at the anastomotic line. Transsacral, transanal, and transperineal approaches were used to remove all fistula tracts. All fistula tracts could be treated under a fine surgical field, and the primary lesion was excised and resutured. Covering ileostomy was recreated. No recurrent disease has been observed 10 months since operation. The transsacral approach was considered to be an option for treating a fistula after restorative proctocolectomy.