Rectovaginal fistula – is a pathological passage between the rectum and the vagina, also known as a fecal fistula. It is a fistula in which stool accumulates in the vagina and is passed through the vagina, especially in the case of loose stools, or in the case of very small fistulas, no stool is passed through the vagina, but there is vaginal discharge. Due to the specificity and complexity of the local anatomy of the lesion, rectovaginal fistulas often lead to unspeakable pain, decreased quality of life, and vaginal impurity and infection, and patients often strongly request surgical repair. Since 1998, we have repaired 12 cases of congenital rectovaginal fistulas using fistula excision sutures and fistula excision local mucosal flap transfer with satisfactory results. The results are reported as follows. 1, Clinical data From February 1998 to March 2006, we admitted 12 patients with congenital rectovaginal fistula. The fistulas were 0.5-2.1 cm in diameter and 1.1 cm in average. 8 of them were ≤1.5 cm in diameter and 4 of them were >1.5 cm in diameter. 2, surgical method 2.1, fistula excision direct suture repair method: 8 cases in this group, fistula diameter ≤ 1.5cm, including 2 cases of medium fistula, 6 cases of low fistula. The patient was placed in a lithotomy position, the skin and vagina were routinely disinfected, sterile towels and sheets were laid, the vaginal hook was pulled open to fully expose the vaginal fistula, and a probe was used to reach the vaginal fistula opening through the fistula tube. About 5 ml of 1.5% lidocaine + 1:200,000 epinephrine solution was used to infiltrate anesthesia around the fistula to facilitate hemostasis and separation. A prismatic incision is made from the edge of the vaginal fistula, and the fistula is completely peeled along the outer wall of the fistula to the rectal wall, and a probe is placed close to the fistula wall by the assistant when separating the fistula, so that the operator can feel the distance between the wall and the probe when separating the fistula, and can better peel the fistula, and the rectal wall around the fistula is closed with a double layer of 3-0 non-invasive suture, and the index finger of the operator’s left hand is inserted into the rectum to prevent the package from penetrating the mucosal layer of the intestinal wall, and the fistula is cut, and the stump is wrapped The fistula is cut out and the stump is buried in the rectal cavity, the bag is checked for completeness and is not torn off, the muscle layer and the vaginal mucosa are intermittently sutured with 1-0 silk thread, and the oiled gauze is rolled into a cylinder and placed on the vaginal wound with moderate tension to achieve the function of pressure to stop bleeding. The oil gauze can be removed on the second day, while the catheter is left in place for 1~3 days after surgery. 2.2. Fistula excision and local mucosal flap transfer method: In this group, there were 4 cases with fistula hole diameter >1.5 cm, including 1 case of median fistula and 3 cases of low fistula. The preoperative and postoperative treatment and anesthesia were the same as above, with prismatic incision from the edge of the vaginal fistula, complete peeling of the fistula along the outer wall of the fistula to the rectal wall, clipping of the fistula, continuous or interrupted inversion of the rectal mucosa with 1-0 silk sutures, complete closure of the endorectal fistula, interrupted closure of the muscular layer with 1-0 silk sutures, and sliding or rotation of the mucosal tissue flap of the vaginal wall around the vaginal fistula to repair the vaginal fistula, with the aim of keeping the two sutures out of the The purpose is to keep the two sutures from being in the same plane. The incision was healed at stage I without serious complications and all cases were followed up for as short as 2 months and as long as 5 years, with no recurrence of fistula, smooth vaginal mucosa and normal sensation and movement. Three of the patients were married and had children 2 to 3 years after surgery, one of them had a cesarean section and two had normal deliveries, with no recurrence of fistula after 7 months to 1.5 years of follow-up. The causes of rectovaginal fistula include injury and non-injury, among which injury rectovaginal fistula includes obstetric birth injury, trauma and inflammatory injury, among which obstetric birth injury is the most common, with a reported incidence of 0.1%, and non-injury rectovaginal fistula includes congenital and cancer. All 12 patients in this group had congenital rectovaginal fistula, which was caused by the downward extension of the mesonephric canal along the posterior wall of the urogenital sinus when the embryo was 6-7 weeks old. Low fistula. A fistula located in the superior rectovaginal septum with a fistula hole ≥2.5 cm or a combined urinary fistula is called a complex fistula. All 12 patients in this group had low to medium simple fistulas. There are several surgical approaches: transanal rectal, transvaginal, peripheral flap, transabdominal and laparoscopic. In addition, there are reports of surgical repair via laparoscopy. In our group, all 12 cases were congenital low to medium rectovaginal fistulas, and all of them were repaired vaginally with more satisfactory results. The author has the following experience through 12 cases of congenital rectovaginal fistula repair since 1998: 1. Adequate preoperative preparation: Adequate intestinal preparation should be performed before surgery. The purpose is to ensure that the intestinal canal is free of feces at the time of surgery, to inhibit intestinal bacteria, to create a subaerobic environment at the surgical site, and to minimize the factors of local infection during surgery. The vagina is douched with 1:2,000 benzamide solution and the vulva is washed twice a day for 3 days before surgery, and if there is eczema on the vulva, the vulva is washed with 1:5,000 potassium permanganate solution, a semi-liquid diet for 3 days before surgery, a liquid diet for 1 day before surgery, oral intestinal antibiotics for 3 days before surgery, and a cleansing enema for the evening and morning before surgery. 2. Appropriate surgical procedure When the fistula is ≤1.5cm, the fistula can be removed, the inward turning of the intestinal mucosa to close the rectal fistula, intermittent suture repair of the layers, so that the tension is not much in the purse suture and intermittent suture of the layers of tissue, when the fistula is >1.5cm, such as mucosal inward turning purse suture, because of the greater tension, the rectal mucosa is easy to tear, feasible continuous or intermittent rectal mucosal inward turning suture, or even in The rectal mucosal stump can be reinforced again with continuous or interrupted sutures, and when suturing the muscular layer, if the tension is too high, mattress sutures can be performed, and when suturing the vaginal mucosa, the vaginal mucosal flap can be used to slide or transfer to repair the vaginal fistula, the main purpose of which is to make the two sutures not in the same plane to prevent postoperative re-post. 3. proper postoperative management: it is very important to keep the number of intestinal voids postoperatively to heal the repaired fistula hole. Diet control plus the application of drugs that inhibit intestinal peristalsis, keep no defecation for 3 days after which you can gradually eat liquid, control the first defecation at 5 or 6 days after surgery, you can take paraffin oil to lubricate the stool, routinely apply antibiotics to prevent infection, if there is dilute stool discharge after surgery, it should be given so as to perform a local cleaning and change of medication afterwards. A 16-gauge catheter was placed in the vagina, and the vagina was rinsed with 1‰ Neosporin solution and saline once or twice a day. The 12 patients with congenital rectovaginal fistula were repaired surgically and all achieved satisfactory results. Because all 12 patients were unmarried and infertile, seven had hymenoplasty within six months to two years after surgery. All patients had good wound healing and no recurrence of fistulas at the postoperative follow-up from 2 months to 5 years, and three of them had no recurrence of fistulas or formation of new fistulas after pregnancy and delivery 2-3 years after surgery, indicating that the results of the above two surgical methods in repairing congenital rectovaginal fistulas are definite and satisfactory.