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Background: Treatment of anal fistula is a balance between maximizing the chances of successful healing and avoiding complications particularly incontinence from division of the anal sphincters. Many surgical procedures have been used in the treatment of anal fistula, with varying success. Endorectal advancement flap can be a useful tool for the surgeon faced with an anal fistula. This study aims to compare outcomes for rectal flap advancement in comparison to seton placement in treating high transsphincteric perianal fistula. Subjects & methods: The study included 54 patients with high transsphincteric perianal fistulas; 27 patients were treated by rectal partial thickness advancement flap and the other 27 patients were treated by seton placement. Results: Results proved to be better with rectal advancement flap than seton regarding time to complete healing, postoperative wound infection, postoperative continence and recurrence. Conclusion: Rectal Advancement Flap was found to be a promising and a more effective procedure than seton with better healing rates and less liability for postoperative incontinence or recurrence. Keywords: High perianal fistula, rectal advancement flap, seton.

RECTAL ADVANCEMENT FLAP TREATMENT COMPARED WITH SETON FOR HIGH TRANSSPHINCTERIC PERIANAL FISTULA