Background: Fistula in ano is a common anorectal problem any surgical procedures are introduced to reduce higher rate of recurrence and maintain anal continence. Newer techniques, modification are in progress since 18th century to get rid from this diseases. Objectives: To analyze the recurrence and fecal incontinence with seton" feeding tube-tie" at secondary care hospital. Method: this prospective study of complex fistula in ano involving more than 30% of anal sphincters or recurrent manage by feeding tube-tie with both sides partial fistulotomies and specially internal opening between 3&6 o'clock from April 2007 to January 2012 at Ghulam Muhammad Mahar Medical College Teaching Hospital SU-II Sukkur & City Medical Centre. Results: One hundred thirteen patients treated during study period, age ranges from 13 to 69 years, complete wound healing found within 6 to 11.4 weeks, seton tightened 6 to 12 times with 3 mm length each time. Recurrence found in 3.5% and incontinence 0% during the minimum period of six months follow up. Conclusion: Feeding tube-tie seton with bilateral partial fistulotomies is, cost effective, simple management with low morbidity and will recommend as procedure of choice for the management of complex fistula in ano.