Background and Objectives: in this review wed discuss background of anal abscess and fistula, as well focused on different surgical approaches for dealing with anal abscess, their effectiveness and difficulties after surgery. Patients and Methods: We conducted narrative review by searching published literatures in the following databases: MEDLINE/PubMed, and Embase, for all studies concerning with types of Anal abscesses and diagnosis in addition to surgical management approaches “June, 2018". Results: Anorectal abscesses are one of the commonest anorectal problems encountered by surgeons. They are usually cryptoglandular in origin and are associated with an anal fistula in 30% – 70% of cases. When the incriminating gland originates from the posterior midline and traverses the conjoint longitudinal muscle into the deep postanal space, a deep postanal abscess results. Further extension of this infective process into the unilateral or bilateral ischiorectal fossa leads to a horseshoe abscess. This type of abscess accounts for about 15% – 20% of anorectal abscesses and its management remains challenging to surgeons. Conclusion: Anorectal abscesses are common anorectal problems, early management is mandatory, almost always require surgical drainage, even if they have spontaneously discharged.