Abstract The aim of this prospective study was to document clinical experience in the surgical management of posterior horse shoe fistula of cryptogalndular origin with a modified Hanley procedure using hybrid elastic glove as a one stage cutting seton. A modified Hanley procedure was applied to 28 patients (20 males and 8 females) presented with posterior horseshoe anal fistula (mean age 41 years) for the period from February 2007 to March 2012, and the surgical results were analyzes. The seton used was fashioned from a surgical glove and was tied around the sphincter under less tension in addition to the excision of superficial segment of the lateral tract and deeper extension into ischiorectal spaces were curetted and packed with gauze socked with povidon iodine. Complete healing was achieved in all 28 patients within three months post-operative period. Recurrence was found in only three patients after six month follow up period. All patients were discharged on the same post-operative day (day case surgery). None required readmission and post-operative pain was mild and bearable. Narcotic analgesics were not needed after discharge. All patients were able to return to their works and daily activity in 2-3 weeks. In conclusion, posterior complex horseshoe anal fistula can be safely and successfully treated with modified Hanley procedure with the use of the hybrid elastic seton.