Abstract Aim Treatment of complex anal fistulae remains a significant challenge for physicians and patients. A sphincter‐preserving technique with bioactive platelet‐rich fibrin matrix is one option. This three‐year study aimed to evaluate the efficacy of bioactive platelet‐rich fibrin matrix in treating complex anal fistulae. Method This retrospective study analysed data from 2019 to 2022 of patients diagnosed with complex anal fistulae treated with a platelet‐rich fibrin matrix at a tertiary centre. Endoanal ultrasound was used to morphologically characterize fistulas using Park's classification. Pearson's chi‐squared and Kaplan–Meier (log‐rank) analyses were used to evaluate between‐group differences. Results A total of 213 patients were included in the study (181 with cryptoglandular fistulae and 32 with Crohn's disease‐associated fistulae) with a median follow‐up of 6.6 months (range 0.5–67.1 months). Cavities and secondary tracts were identified in 14.6% and 34.7% of the patients, respectively. External opening closure occurred in 32% after one procedure and 43% cumulatively after a second intervention. Healing rates did not differ statistically by aetiology or fistula location. Cavities and secondary tracts were associated with failure. During follow‐up, 23% of the secondary tracts healed, whereas cavities derived no significant benefit from the intervention. No serious complications were reported. Conclusion Platelet‐rich fibrin matrix is a simple and safe sphincter‐preserving technique that achieves reasonably good results in the treatment of cryptoglandular and Crohn's disease‐associated fistulae. While secondary tracts may respond well, further research is required to optimize the management of fistulae associated with cavities.