[Complex perianal fistula: diagnosis and treatment]

After a detailed discussion of the question of perianal fistulas, the authors use their own experience to examine complex perianal fistulas (trans-sphincteric with involvement of the puborectal muscle, high intersphincteric, extrasphincteric and supersphincteric) which represent 5-15% of cases. They affirm that elective treatment consists of surgical silk to ensure the optimal drainage of the fistula and provoke sclerosis of adjacent tissues, followed after 9 weeks by either the slow section of the fistula using a silicone ligature or direct fistulotomy. No cases of incontinence or recidivation were observed using this method in 29 cases treated between 1990 and 1992 who were followed up for between 6-24 months.