Background Management of transsphincteric perianal fistula is mainly surgical; fistulectomy, fistulotomy, or ligation of intersphincteric fistula tract LIFT technique shows diversity in their outcome. Continence status is considered the most important point in the treatment outcome followed by recurrence rate and local wound complications. The emerged LIFT technique was claimed for a better outcome.. In this study, our aim is to compare between LIFT technique and fistulectomy in transsphincteric perianal fistulas. Patients and methods In all, 78 patients with transsphincteric perianal fistula were randomly allocated into group A: 39 patients who underwent LIFT and group B 39 patients who underwent fistulectomy. The patient follow-up and operative data were recorded and properly analyzed. Results The preoperative and demographic data between both groups show nonsignificant differences. Operative time was significantly shorter in the fistulectomy group. In the LIFT group recurrence and nonhealing of fistula were significantly higher (six cases) versus one in the fistulectomy group. Incontinence is significantly higher in the fistulectomy group (four cases) and zero in the LIFT group. Wound infection and dehiscence were more in the LIFT group. Conclusion In the treatment of transsphincteric fistula, LIFT technique led up to a lower incontinence rate than fistulectomy, but fistulectomy has proved to have a lower recurrence rate. Keywords: fistulectomy, ligation of intersphincteric fistula tract, perianal fistula