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BACKGROUND: The long-term closure rate of high perianal fistulas after treatment remains disappointing. OBJECTIVE: The goal of this study was the long-term closure rate of high cryptoglandular perianal fistulas mucosal advancement flap with platelet-rich plasma. DESIGN: This study retrospective in design. SETTING: This study was conducted at 2 tertiary referral hospitals. PATIENTS: Patients presenting with high cryptoglandular perianal fistulas involving the middle/upper third of sphincter complex were included. INTERVENTIONS: A staged surgical performed; After seton placement, a mucosal advancement flap was platelet-rich plasma. MAIN OUTCOME MEASURES: Recurrence was the main Incontinence was the secondary outcome. RESULTS: We operated on 25 between 2006 and 2012. Thirteen (52%) patients had previous fistula median follow-up period was 27 months. One patient (4.0%) was lost to after 4 months. Freedom from recurrence at 2 years was 0.83 (95% CI, Two of the 4 patients with a recurrence (8%) had a repeated treatment One patient (4.0%) refused another treatment, but agreed to stay in One patient (4.0%) requested a colostomy, resulting in closure of the Complications occurred in 1 patient (4.0%). Incontinence numbers were median Vaizey score of 3.0 out of a maximum of 24. LIMITATIONS: The limited by its retrospective design, lack of preoperative incontinence selection bias, and phone interview follow-up. CONCLUSION: The long-term results of patients with primary and recurrent high cryptoglandular fistulas treated with a seton followed by mucosal advancement flap and platelet-rich plasma show low recurrence, complication, and incontinence Therefore, this technique seems to be a valid option as treatment. preferably randomized controlled studies are needed to further explore surgical technique.