Background: The placement of seton is one of the common sphincter-saving procedures for high fistula-in-ano (FIA). It has been described since Hippocrates who first used horse hair as a seton for the treatment of anal fistula. Objective: The aim of this study is to investigate the predictive factors for recurrence and to evaluate the efficacy and complications of seton treatment for high transsphincteric perianal fistula. Patients and methods: Our study was a prospective study, on a sample size of 50 patients (43 males and 7 females) of high perianal fistula, carried out in Bab-Alsharia University Hospital. Results: In our study 66.7 % of recurrent cases had history of previous fistula surgery. Fecal incontinence was recorded in 3/50 (6%) patients in our study. Factors associated with higher rates of fecal incontinence (FI) after fistula surgery included high transsphincteric or suprasphincteric fistula, horse-shoe fistula, female patients, and patients older than 45 years. Conclusion: Factors that significantly predicted the recurrence of FIA were previous fistula surgery, anterior anal fistula, and presence of secondary tracks or branches as with supralevator extension, and horse-shoe fistula. Female patients and horse-shoe fistula were the significant risk factors for developing FI after the placement of seton.