This video illustrates the case of a 69 year old male presenting with horseshoe abscess originating in the deep postanal space. On examination this patient had a posterior midline transphincteric fistula (TFIA) with a seton in place. In view of the complexity of the anal fistula a surgisis anal fistula plug was offered to the patient. This video demonstrates the preoperative preparation, the positioning and the proper steps for insertion of a bioabsorbable matrix anal fistula plug, (AFP) for a one stage treatment of TFIA. The postoperative instructions and follow-up are also discussed. Insertion of a bioabsorbable matrix anal fistula plug under regional anesthesia for a fistula originating from deep postanal space. Successful insertion demonstrated and preoperative and postoperative care discussed. Bioabsorbable anal fistula plugs can be used in select patients for the management of transsphincteric anal fistula.