Background: anal fistula is a common proctologic problem. It is a common cause of chronic irritation to both patients and surgeons. It is a disease of antiquity. Even with all that work and research, started 2500 years ago, or may be more, man didn't find the ideal treatment for perianal fistulas. Objective: The purpose of this study is to evaluate sphincter saving techniques used in management of transsphincteric anal fistula as regard rapid recovery, incidence of postoperative stool incontinence and recurrence rate. Patients and Methods: our study was a prospective study of 60 patients who had transsphincteric anal fistula and were admitted to Al-Azhar University Hospitals from July 2017 till January 2019. The patients were divided into 3 groups according to the management procedure, group A was managed by seton technique, group B was managed by ligation of transsphincteric fistula tract (LIFT) and group C was managed by endorectal advancement flap (ERAF). Results: there were no differences of demographic data and characters of fistula among the three groups, however some differences were noticed regarding postoperative morbidity due to early complication including urine retention, bleeding, hematoma, infection and wound disruption but it was not statistically significant, there were statistically significant difference regarding postoperative pain, recurrence and incidence of stool incontinence. Conclusion: high transsphincteric fistula warrants more sphincter sparing techniques to avoid the most likely sphincter dysfunction which could be happened after traditional surgery like fistulectomy and cutting seton for this type of complex anal fistula.