Our experience with complete fistulectomy with primary sphincter reconstruction started already in 2004. Since then we have gained experience in up to 1,000 patients. In a retrospective study, we evaluated detailed results. In this study, 148 patients (51 females) with a mean age of 48 years were operated. In 43 % surgery was applied for recurrences following other fistula operations, 16 % were suprasphincteric and 84 % transsphincteric situations. No patient was operated with a covering stoma. The primary healing rate after a mean follow-up of 20 months (12–48 months) was 85 %. Adding revisionary surgery, this reaches 89 %. Recurrence and a number of previous operations had a significant influence on the outcome, whereas age, sex, smoking, other anal operations, and concomitant medication did not. In all patients new onset of incontinence was observed in 25 %, but the majority of these patients suffered from incontinence for flatus (16 %) and liquid stool (8 %). These results could be confirmed by others (Table 10.1). Overall recurrence rates are mostly around 10 % with acceptable low rates of incontinence.