The treatment of anal fistulas aims at complete sustained remission of the disease with the maintenance of functional sphincters and anal incontinence. To achieve optimum therapeutical results, thorough diagnostics and selection of appropriate operative or non-invasive technique is crucial. Recent advances in modern therapeutical approaches in the treatment of anal fistulas have led to the establishment of novel sphincter-preserving methods. The increasing interest in these techniques in the last years may be due to good experience with long-term remissions, minimal incontinence risk or both. Nevertheless, surgical treatment of fistulas retain its preferred indication in a considerable proportion of patients. In this article the authors give a brief overview of etiological factors, diagnostic means and classification of anal fistulas. They further discuss the relevance of the traditional surgical treatment in the light of modern invasive and non-invasive procedures.