An analysis was made of the indications and outcome of immediate reconstruction of the anal sphincter after fistulectomy in the management of a selected group of patients who were at risk of post-operative incontinence. A total of 31 patients underwent surgery, with 25 high trans-sphincteric fistulas (80.6%), four low trans-sphincteric fistulas (12.9%), and two suprasphincteric fistulas (6.5%). The median post-operative stay was 7.0 days, with a median follow up of 24.0 months. We describe one case (3.2%) of post-operative infection and dehiscence of the muscle suture. The fistula recurred in three patients (9.7%). At the end of follow up of 25 patients with full preoperative continence, five patients (20.0%) presented with perianal soiling and one (4.0%) had incontinence to flatus. Sphincter reconstruction after fistulectomy constitutes a management option that should be considered in the treatment of certain fistulas. It allows both rapid recovery and the preservation of anal function.