Surgery is required for all types of congenital anorectal malformations. However, there are different surgical times and procedures depending on the type of malformation and the size of the fistula. Current surgical methods include: fistula excision with layered sutures, rectal mobile flap repair, and sacro-abdominal perineal surgery. The goal of surgery is to restore bowel function with normal control. Rectovaginal fistulas are difficult to operate again due to their complex causes, complicated types, post-operative infections, and high recurrence rates, and the choice of the procedure is extremely important to achieve a successful outcome. The fistula can be repaired vaginally or rectally by removing the fistula and suturing it in layers. The advantage is that the procedure is simple and easy to perform. The disadvantages are high recurrence rate and uneven separation of rectal or vaginal tissues due to tension in the suture, so the mucosal muscle flap should have adequate blood supply. 2, rectal mobile flap repair Noble first used rectal mobile flap repair to treat rectovaginal fistula in 1902. Recently, most scholars, believe that this method should be preferred for repairing low rectal fistula. 3.Sacro-abdominal perineal surgery Since the anal levator is only about 1.5 cm from the anus in newborns, it is very easy to damage the puborectal ring when separating the rectum in the perineum. The sacrococcygeal incision can clearly identify the puborectal ring, and it is easy to free the rectum, and it is also easier to separate and remove the fistula with high fistula. The procedure is suitable for children who are 6 months or older after birth. For congenital anal anomalies and rectovaginal fistulas, attention should be paid to: (1) the surgical approach and method of operation; (2) the adequacy of freeing the end of the rectum; (3) avoiding serious infection; and (4) fully loosening the end of the rectal mucosa to achieve a tension-free suture. Anal atresia combined with low rectovaginal navicular fistula: For cases with small fistula openings and difficulty in defecation after birth, a neonatal stoma can be made. If the fistula and the vaginal opening seem to be very close to each other, then an anoplasty is performed after 4 to 5 years of age. If the vaginal fistula is large and the feces is passed freely, early surgery is not necessary, but is more appropriate at 3 to 5 years of age. For acquired rectovaginal fistulas, especially those of medical origin, the timing of surgery should be carefully chosen and the patient should not be operated immediately because of the urgency of the request. Surgery should wait until all inflammation has subsided and the scar has softened, 3 months after the injury or repair has been performed. If the fistula is large wait for 6 months. Also all inflammation must be properly drained.