This study evaluates low transsphincteric anal ifstula managed by serial setons and interval ifstulotomy, with attention to healing without recurrence and preservation of continence.Folowing Institutional Review Board approval, consecutive anal ifstula operations performed by a single surgeon from January 1, 2009 to December 31, 2013 were retrospectively reviewed using electronic medical records and telephone interviews for patients lost to folow up. Of the 71 patients, 26 (37%) had low transsphincteric ifstula (23 males and 3 females; mean age: 46 years), treated at our institution by seton placement folowed by interval surgical muscle cutting and subsequent seton replacement or ifnal ifstulotomy. Of the 26 patients, 22 (85%) were initialy referred due to previous failed treatment, with a 30.6 month mean duration of ifstula prior to referral and a mean of 2.2 (range: 0–6) prior anorectal surgeries. At a mean folow-up of 11.9 months, none of the 21 patients experienced recurrence or fecal incontinence. Serial seton with interval muscle-cutting sphincterotomy folowed by complete ifstulotomy is an effective treatment for the management of patients who are either initialy seen for low transsphincteric ifstula, or referred after failed anorectal surgery for that condition.