BACKGROUNDPerianal fistulas are distressing for the patient and sometimes a challenge for the surgeon. Different methods for the treatment of perianal fistulas have a range of success rates and use of the cutting seton is still debatable.OBJECTIVESWe evaluated the recurrence, success rate and incontinence with the cutting seton method for treating perianal fistula.DESIGNProspective, descriptive study.SETTINGAl-Hada Armed Forces Hospital, Department of General Surgery, Taif, Saudi Arabia.PATIENTS AND METHODSWe studied all patients with high perianal fistula admitted to the department of general surgery in our hospital with a diagnosis of perianal fistula in the period from December 2012 to December 2013 (12 months). Patients were followed for postoperative recurrence and incontinence rate.MAIN OUTCOME MEASURE(S)The primary outcome measured was either complete cure or recurrence.RESULTSFifty-one patients underwent cutting seton insertion for fistula in ano. The recurrence rate was 9.8%. The postoperative rate of incontinence was 15.7% to flatus and 5.9% to fluid stools. There was no incontinence to solid stools.CONCLUSIONThe cutting seton is a valid option for a complex fistula in ano, but in female patients and those with previous peri-anal surgery, other surgical options are advised.LIMITATIONSPatients with low perianal fistula, Crohn’s disease, acute perianal abscess and patients with major incontinence were excluded.