Recurrent Multiple Complex Anal Fan-Shape Fistula

Introduction: Fortunately, recurrent multiple complex anal fistula is an uncommon pathology; however, it is at times frankly impossible to cure and entails considerable fear regarding application of the therapeutic option. Surgical techniques are varied, failure can have fatal consequences, and experience is minimal. Objective: Report the case of a patient with diagnosis of recurrent multiple complex anal fistula and his surgical treatment by classic fistulectomy and anal sphincter reconstruction. Methods: Male patient, age 42 years, without significant history for the present condition, with presence of a single anal fistula of 12 years' evolution. First surgery with fistulotomy 3 years prior. Suffering relapse, with clinical classification of complex, patient was reoperated one year later, applying a seton on a single fistulous tract, reporting 2 additional tracts and biweekly adjustment for seven months without improvement. Patient was evaluated by our service, finding 5 secondary orifices with tracts of up to 12 cm from the edge of the anus, with a single primary tract in the 6 o'clock sector at the level of the toothed line. Patient was subjected to surgical protocol, performing fistulectomy with complete section and plasty of the anal sphincter complex. Patient was diagnosed with recurrent transsphincteric complex “fan-shape” fistula with five fistulous processes, with satisfactory postoperative evolution, presenting complete healing and without sequelae. Conclusions: Fistulectomy, although presently proscribed, is resolutive; it is believed to entail a high risk of incontinence, which can be avoided with precise anatomical knowledge and proper application of surgical technique.