Background: Management of transsphincteric perianal fistula is mainly surgical, fistulectomy, fistulotomy, or LIFT technique shows diversity in their outcome, continence status is considered the most important point in treatment outcome followed by recurrence rate and local wound complications, the emerged LIFT technique was claimed for a better outcome, here in this study our aim is to compare between LIFT technique and fistulectomy in transsphincteric perianal fistula. Patients and Methods: 78 patients with transsphincteric perianal fistula were randomly allocated into group A 39 patients under went LIFT and group B 39 patients underwent fistulectomy, patient follow up and operative data was recorded and properly analyzed. Results: The preoperative and demographic data between both groups shows non- significant differences, operative time was significantly shorter in fistulectomy group, in LIFT group recurrence and non-healing of fistula were significantly higher (6 cases) versus 1 in fistulectomy group, incontinence significantly higher in fistulectomy group (4 cases) and zero in LIFT group wound infection and dehiscence were more in LIFT group. Conclusion: In treatment of transsphincteric fistula, LIFT technique led up to a lower incontinence rate than fistulectomy but fistulectomy has proved a lower recurrence rate.