This study scrutinizes supralevator fistula and evaluates a method of successful management. We reviewed 3,190 anorectal operations done between January 1970 and July 1976; 370 of these were for fistula, an incidence of 11.7%. Our data of 350 low or midlevel fistulas and 17 supralevator fistulas (seven deep ischiorectal sinuses and ten high intermuscular abscesses intraluminally drained) are correlated with those from another series. Three extrasphincteric fistulas were studied. The initial origin of these fistulas is cryptoglandular disease with the extrasphincteric supralevator fistula probably resulting from surgery. Surgical technics are described. Improper management of supralevator abscesses can result in an iatrogenically produced extrasphincteric fistula, a difficult and sometimes impossible fistula to cure.