Aim: The aim of this study was to evaluate different clinic-pathological variables affecting outcome of 
surgical management of complex anal fistulas in terms of recurrence and anal incontinence.
Methods: Ninety six patients with complex anal fistulae were included in this study. Fistulotomy operation 
was done for eighty two patients (85.4%). Fourteen patients (14.6%) with high anal fistulas were operated by 
two stages Seton technique. Post-operative recurrence and incontinence, as outcomes, were detected by the 
surgeon in outpatient clinic. Analysis of demographic, clinical and pathological criteria of these patients was 
done to determine factors affecting these outcomes.
Results: Recurrence occurred in eleven patients (11.5%), while minor incontinence was found in fifteen 
patients (15.6%). Surgical management of complex anal fistulas with multiple external openings showed 
significant increase in the incidence of recurrence, incontinence, and delayed wound healing. Female gender 
and older age showed significant relation with incontinence.
Conclusion: Female gender, older age and fistulas with multiple external openings are associated with 
increasing risk of recurrence, incontinence, and delayed wound healing. Sound understanding of the anatomy 
of the fistulous tract and its relation to anal sphincter in addition to factors affecting outcomes is a must for 
proper planning for surgical management of complex anal fistula.