Purpose: To report 12‑month clinical, functional and patient‑reported outcomes after video‑assisted anal fistula treatment (VAAFT) for complex cryptoglandular fistula in an Australian public–private setting. Methodology: Prospective two‑centre cohort of consecutive adults undergoing VAAFT (May 2023–Sep 2024). Primary outcome was healing over 12 months (clinical cure, treatment failure, recurrence, time to recurrence). Secondary outcomes included re‑intervention, day‑surgery feasibility, continence (Revised Faecal Incontinence Scale), quality of life (modified Crohn’s Anal Fistula Quality of Life instrument), analgesia use, and 30‑day morbidity. Results: Twenty‑two patients were treated (median age 43; 86% male); all had prior Seton drainage and 27% had failed LIFT. Internal opening was identified in 95% of patients; most were closed with sutures (90%). Median operating time was 45 min. Healing peaked at 4 months (77%) and was 64% at 12 months. Treatment failure occurred in 9%; recurrence in 27% (median 139 days). Re‑intervention occurred in 36% (cutting Seton 23%; LIFT 9%; fistulotomy 5%). Ninety‑one percent were managed as day surgery (median stay 7 h). No patient experienced worsened continence. Quality of life improved in 64% and median overall score fell from 29 at baseline to 0 at 12 months (p<0.001). Opioid exposure was minimal (median 13 morphine‑milligram equivalents inpatient; 0 outpatient). Conclusion: In this prospective Australian cohort, VAAFT delivered ambulatory sphincter‑preserving fistula care with preserved continence and substantial quality‑of‑life improvement. Healing attenuated after 4 months, with most failures clustering within 5 months, supporting structured early surveillance and transparent counselling on durability.