A novel hybrid video-assisted technique with a silk seton shows promising results for managing transsphincteric anal fistulas.

• Primary healing achieved in 90% of patients within 16 weeks, with a median healing time of just 5 weeks.
• Recurrence rate at 1-year follow-up is low, at 6.6%, with an overall failure rate of 9.8%.

This approach can enhance patient recovery and minimize complications, making it a viable option for surgeons treating complex anal fistulas.

• Spontaneous seton expulsion occurred in 63.9% of cases at a median of 4 weeks.