Anorectal abscess and fistula-in-ano are common morbidities encountered in outpatient clinics. The most common etiology is cryptoglandular disease, accounting for 90% of anorectal abscesses, although multiple etiologies are known, including Crohn’s disease, obstetric injury, fissure, and infection. It is necessary for the surgeon to understand the pathophysiology and anatomy of the anal canal and pelvis and appropriate patient management based on the underlying etiology. At least one-third of cryptoglandular abscesses will progress to fistula. Anorectal abscess should be treated with surgical drainage. Anal fistula should be evaluated with examination under anesthesia prior to determining subsequent management. With any surgical management, control of sepsis and maintenance of continence are imperative. The attempt at local closure of a particular fistula is influenced by the patient’s symptoms, anatomy of the fistula, quality of the surrounding tissues, and previous attempts at fistula repair. Failure rates of sphincter-preserving techniques are significant, and, when one method fails, it may be important to attempt an alternative approach. Failure rates and recurrence should be discussed during the informed consent process and patient expectations set at the initiation of treatment.