Background: High perianal fistula treatment remains challenging, mainly due to variability in success and recurrence rates as well as continence impairment risks. So far, no procedure can be considered the gold standard for surgical treatment. Yet, strong efforts to identify effective and “complication-free” surgical options are ongoing. Fistulotomy can be considered the best perianal fistula treatment option, providing a perfect surgical field view, allowing direct access to the source of chronic inflammation. Controversy exists concerning the risk of continence impairment associated with fistulotomy. This study aimed to assess the outcomes of fistulotomy with immediate sphincteric reconstruction as regard fistula recurrence, incontinence, and patient satisfaction. Methods: This interventional study was carried out at the General Surgery Department, Zagazig University Hospitals during the period from July 2018 to December 2019 on 24 patients with a clinical diagnosis of a high transsphincteric fistula-in-ano. The fistulous tract was laid open over the probe placed in the tract. After the fistula tract had been laid open, the tract was curetted and examined for secondary extensions. Then suturing muscles to muscles including the internal sphincter and external sphincter by transverse mattress sutures. Results: Our study showed that two patients develop incontinence to flatus about 8.3%.and only one patient develop incontinence to loose stool, 4.2%. Complete healing was achieved in 83% and recurrence was 16.6%. Conclusion: Fistulotomy with immediate sphincteric reconstruction is considered to be an effective option in the management of high perianal fistula with low morbidity and high healing rate with acceptable continence state. Keywords: