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The treatment of transsphinteric anal fistula (TSAF) is difficult. The study evaluated clinical and functional results of the anal fistula plug (AFP) as compared to conventional fistulotomy with a cutting seton (CS).From 2007 to 2010, 16 patients with TSAF were treated using a SURGISIS AFP in eight patients and CS in eight patients. TSAF was diagnosedpreoperatively with endoanal ultrasound and MRI. Anorectal manometry (ARM) was performedpre- and postoperatively. The number of patients with successful treatment andpreserved anal continence determined by the Cleveland Clinic Faecal Incontinence Score (CC-FIS) and adverse events were recorded.Two of eight patients in the AFP group developed septic complications, resulting in plug removal in one case. The mean time to complete fistula healing was 6 weeks. In the CS group the mean time to healing was 24 weeks, two of eight patients required revisional surgery. The CCF-FIS was not significantly reduced in AFP group, falling from 8.3 to 7.8; in the CS group it was significantly reduced, from 8.6 to 7.1. On ARM at 3 months, both anal resting and squeezepressures were significantly reduced in the CS group compared to the AFP. Endoanal ultrasound revealed marked anal sphincter defects in six of eight patients in the CS group.Compared with conventional fistulotomy, the anal Fistula Plug is an effective, well-tolerated treatment for TSAF.