2026 Chinese guideline refines presacral cyst classification and surgical approach selection

The 2026 Chinese presacral cyst guideline refines anatomical classification (midline, S4, cavities, sacral distance) and tailors surgical approach indications, enabling individualized plans. It also standardizes complex case management and reconstruction.

• New anatomical classification incorporates sagittal midline, inferior margin of S4 vertebra, number of cyst cavities, and distance to sacrum.
• Indications for transperineal, transsacrococcygeal, transabdominal, and combined approaches are detailed under the new classification.
• Recommendations added for complex management (fistulas, neuroprotection) and reconstruction with gluteus maximus flaps.

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