Low rectovaginal fistula is a fistula close to the dentate line or labial tether. The common causes are: (1) congenital, (2) birth injury (some patients have a combination of anal sphincter injury), (3) foreign body, (4) surgery (e.g., rectal cancer surgery or surgery for uterine fibroids or cervical cancer), (5) after radiation therapy, and (6) from anal fistula. Low rectovaginal fistula repair surgery is prone to failure and has a low success rate, which is the problem of the century. Dr. Ping Huang of the First Affiliated Hospital of Nanjing Medical University, after a long exploration, concluded that the three basic conditions to ensure the success of low rectovaginal fistula surgery are: ① No infection. ②Good blood supply. ③Tension-free repair of the rectal wall. The tension-free repair of the rectal wall is the key to ensure the cure of low rectovaginal fistula. (1) For rectovaginal fistulas with an opening of less than 0.5 to 1.0 cm, a local repair through a perineal incision is used. In other words, the perineal incision is fully freed from the rectal wall around the fistula, and tension-free sutures are performed after debridement. If there is a combined anal sphincter injury, anal sphincter repair is performed at the same time. (2) For rectovaginal fistulas or refractory rectovaginal fistulas with fistula openings >0.5-1.0 cm, a modified Bacon procedure is used. In other words, the large intestine is freed to the upper edge of the surgical anal canal, the mucosa above the dentate line is removed, the large intestine is pulled out through the anal canal without tension, and then the large intestine outside the anus is removed after natural healing. There are two types of surgery for modified Bacon procedure: laparoscopic modified Bacon procedure and open modified Bacon procedure. (1) Generally, laparoscopic modified Bacon procedure is used for rectovaginal fistulas without a history of abdominal or pelvic surgery. (ii) Generally, open modified Bacon procedure is used for rectovaginal fistula with a history of abdominal and pelvic surgery. None of the above mentioned procedures require a protective enterostomy.