Anal fistula has been recognized for centuries, and yet, its treatment remains a challenge for surgeons till today. in this study, a 30 year experience of treating anal fistula is being reported and discussed in light of the various recognized management methods. A total of 320 patients were treated by fistulotomy, fistilectomy, fistula plugging, or seton technique. Data showed that fistula plugging carried the highest failure rate (89%) seconded by fistulectomy (37%), seton procedure (24,5%) and fistulotomy (15,6%). High transphincteric fistulas were more likely to predict failure compared to low transphinteric; intersphinteric and subcutaneous fistulas (37,5% versus 9,5 %, 7,3% and 0% respectively). In clnclusion the scales seem to support fistulotomy. However, no standardized algorithm exist to guide the care of patients and the choice of operation is based on patient-related factors, the patient's surgical hispory and the surgeon's experience and familiarity with the various techniques for treating anal fistula.