Abstract Background: Seton is defined as a string-like material that can be tied through the fistula to induce an inflammatory reaction leading to fibrosis that fixes the sphincter and prevents its retraction when it is divided. Seton is commonly used by surgeons for treatment of complex anal fistula (complexity means: Fistula crossing >30% to 50% of the external anal sphincter, recurrence, multiple tracks, or co-existence of anal incontinence). Aim of Study: To detect the anal incontinence and recur-rence rate when we treat patients suffering from complex anal fistula by cable tie seton at a university hospital. Patients and Methods: Our study is a prospective case series including patients with complex anal fistula i.e. recurrent fistula, managed with cable tie seton from May 2015 to July 2018. Patients were followed up in the outpatient clinic after one week of seton insertion and then every two week. At each visit time, the cable-tie was tightened enough if found loose without anesthesia. Incontinence was inquired about using wexner's score. Results: During the study period, Seventy nine patients were treated. Their age was (mean ±  standard deviation) 41±10.6 years. Tightening of the seton was done with a median of six times (3-15 times range). All patients had complete healing in 11.2±5.7 weeks. Follow-up was done for all patients for a variable period with minimum of one year and none of the them had any anal incontinence. Recurrence was noticed in 4 (5%) patients. Conclusion: The cable tie seton proved to be safe for the patients, cost effective and had low morbidity when used for the treatment of complex fistulae in-ano. Therefore, it can be recommended as standard method for treating complex fistulae-in-ano.