The process of anaerobic digestion has been and still remains the most efficient, cost effective and environmentally benign treatment process for poultry slaughterhouse wastewater (PSW). The PSW is characterized by a high concentration in chemical oxygen demand (COD), biological oxygen demand (BOD) and fats, oil including grease (FOG). The reactor configuration influences the performance of such anaerobic systems in the treatment of such oily wastewater. The up-flow reactor configuration provided by the Up-flow Anaerobic Sludge Blanket (UASB) Bioreactor or the Expanded Granular Sludge Bioreactor (EGSB) are highly dependent on up-flow velocity, which often contributes to periodical sludge washout during the treatment of PSW with high FOG and total suspended solids (TSS) concentration, resulting in poor reactor performance in comparison with downflow reactors such as the Static Granular Bed Reactor (SGBR), which achieves high organic load removal efficiency particularly when treating PSW due to its ability to retain sludge granules and solidified residue within the reactor. The washout of the sludge results from sludge flotation, which is induced by the inhibition of the anaerobic granular biomass by the accumulation of long chain fatty acids (LCFAs) from poor hydrolysis. The aim of this review is to highlight reactor configuration deficiencies, and to elaborate on the advantages of using anaerobic digestion for the treatment of FOG-laden PSW, with a focus on reactor performance. Additionally, a comparative analysis between up-flow reactors, such as the UASB including EGSB, and downflow reactors, such as SGBR, was performed.