A 55-year-old man presents with abdominal pain and rectal bleeding. He has a 20-year history of Crohn’s proctocolitis and has perianal disease. He was treated with infliximab for 5 years but developed anti–tumor necrosis factor (TNF) antibodies. He had an allergic reaction to adalimumab. He has been on usketinumab for the past year with minimal improvement. You drained two prior perirectal abscesses and placed setons in the past 2 years. He currently has minimal complaints from the indwelling setons. A recent colonoscopy confirmed the persistence of chronic active proctosigmoiditis without evidence of dysplasia on multiple biopsies. He reports signficant disruption of his life and work and "wants this disease controlled, even if it means an ostomy." On physical examination, the abdominal is soft and minimally tender. Anorectal examination shows a well-controlled transphincteric fistula with seton without evidence of sepsis. Which of the following surgical options is most appropriate for this patient?
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