Introduction: Ano-rectal fistula stills a common surgical problem facing surgeons. For a long time fistulotomy remains standard treatment for simple fistulas. However in cases of complex fistulas, fistulotomy carries the risks of sphincter damage and incontinence. For these reasons, sphincters saving techniques come into view. These techniques include fibrin sealant, anal fistula plug (AFP), cutting seton and mucosal advancement flap. The aim of this study was to assess the outcome of AFP (Gore's plug) procedure in a group of patients with complex peri-anal fistulas, and to assess whether the results were compatible with previous international findings. Patients: 41patients complaining of complex ano-rectal fistulae were enrolled for treatment with anal fistula plugs. Five cases were excluded and the study was completed with 36 cases filling the inclusion criteria that were put for the study. MRI was used to determine the anatomy and types of the fistulas. Accordingly, the patients in the study were 8 with recurrent inter-sphincteric fistulae, 17 with trans-sphincteric fistulae, 7 with combined inter-sphincteric and transsphincteric fistulae, and 9 with supra-sphincteric fistulae. Setons were used preoperatively for all patients at least one month prior to surgery. Methods: All patients were operated upon while in Lithotomy positions. The plug was prepared by immersing in normal saline for 5 minutes prior to use. The plug was fashioned and tailored to suit the fistulous track. After positioning inside the track, the disc of the plug was sutured at the internal opening of the fistula with non-absorbable suture. The external opening was left open to allow for drainage of the tract. In patients with 2 tracks, 2 AFPs introduction was tried. followed up included hospital stay, postoperative pain and plug dislodgement, state of continence, fistula closure and quality of life. Early dislodgement of the plug was followed by repetition of the procedure. Results: 32 patients with single fistulous track had successful introduction of one AFP. 4 patients (11 %) had 2 fistulous tracks with 2 external openings, (all are posterior), 2 AFPs were introduced successfully inside the 2 tracks; with total 40 AFPs used primarily. Early dislodgement of the AFP occurred within the first week in 4 patients (11 %) who needed reoperations with re-insertion of other plugs. 26 patients (72.2 %) showed complete cure of their fistulae as evidenced by closure of the internal and external openings and absent discharge. The failure rate was 27.8%. Their distribution was as follow; 2 patients (5.5 %) of those who underwent repetition of the procedure (due to early dislodgement of their plugs), 3 patients (8.3 %) of those had 2 fistulous tracks (persistence of their 2 fistulae), 2 patients (5.5%) had recurrent transsphincteric and 3 patient (8.3 %) had supra-sphincteric fistula. Conclusion: Anal fistula plug appears to be a promising and safe alternative to the current treatment options for high or complex perianal fistulas in them, such options may carry the risk of recurrence or sphincter derangement with high rates of minor or major incontinence. Key words: Anal fistula plug - Sphincter saving technique – Ano-rectal fistula.