BACKGROUND Fistula in ano is a common perianal disease of the mankind. It is secondary to mainly cryptoglandular infections & abscess. Persistence of chronic infection will lead to fistula formation. 1 Management of high-level fistulas is complicated due to incontinence, which is troublesome; hence, many procedures have been tried by many surgeons, but without any supremacy over others. Immediate reconstruction of divided sphincter muscle will give good result. 2 We have done fistulectomy &

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... ir of the external anal sphincter & followed for the last two decades with no incontinence & minimal recurrences. METHODS 192 cases of fistula in ano for the last 20 years operated by a single surgeon (1 st author) were studied & were followed up to now. The differences, in the selection of cases, surgical skill & post-operative management are excluded in the study by including cases done by a single surgeon (first author) only. 136 males & 56 females were operated. Intersphincteric 45.8%, trans-sphincteric 49%, high level fistulas 5.2%, trans-sphincteric & high fistulas with considerable external sphincter loss (54 cases) were repaired with 1-0 Vicryl. Fistula in ano is associated with haemorrhoids in 24/192 & ano rectal abscess (20/192). Fistulotomy done in 16/192, simple & subcutaneous tracts -fistulectomy done in 65%. Curetting of the high tracts done in 16/192. RESULTS Males are predominantly affected 70.8%. This is more common in 3 rd , 4 th & 5 th decades (80.1%). Single external opening was seen in (90%). Posterior & lateral fistula tracts are more commonly seen in (89.6%). Non-specific pyogenic infective pathology is seen 99%. Recurrences-6/192. Time taken to heal is 3-6 weeks. Incontinence is not seen in any case. No recurrence or incontinence seen in primary sphincter repair of 54 cases. CONCLUSIONS Primary sphincter repair is simple & best procedure with minimal or no recurrence & decreases the healing time. It is more suitable & advised in fistulas with considerable external sphincter loss.