Aims and Objectives: Fistula-in-ano is a complex problem in anorectal surgery. The nature of the disease makes it a psychosocial morbidity. Despite the advances, the ideal treatment remains elusive. One of the recent treatment options is video-assisted anal fistula treatment (VAAFT). The aim of our study is to study the epidemiology of the disease and compare the results of VAAFT with fistulectomy for treatment of fistula-in-ano. Methods: This is a randomized comparative interventional study that includes 70 patients with the diagnosis of simple fistula-in-ano. Patients were randomly divided into two groups: Group F (fistulectomy) had 36 patients and Group V (VAAFT) had 34 patients. Both groups were evaluated according to the operative time, post-operative hospital stay, pain, analgesia requirement, postoperative complications, time of wound healing, fecal incontinence, and recurrence. Results: Both groups were comparable for baseline demographic variables. Post-operative hospital stay was less in group V, 1.85 days compared to group F, 7.03 days (p-value <0.001). Post-operative pain was significantly less in group V compared to group F. Total analgesia requirement was less in in group V, 2.94 vs 7.69 (p<0.001). Post-operative complaints such as bleeding, infection and urinary retention were less in group V but the difference was statistically insignificant. Wound healing was significantly faster in group V, 97.1% at 1 month compared to 55.6% in group F (p<0.001). The incidence of fecal incontinence and recurrence was also compared but difference was insignificant. Mean operative time was higher in group V, 62 vs 35.14 (p-value < 0.01). Conclusion: VAAFT is a minimally invasive, sphincter-saving procedure offering many advantages like short hospital stay, less pain, faster wound healing and low morbidity. Our initial results with the procedure are encouraging but larger studies are needed to arrive at definite conclusions.