Pediatric rectal vestibular fistula 23 cases (including 18 cases of rectal navicular fossa fistula, 4 cases of rectal labia fistula, 1 case of rectovaginal fistula), age 6 months ~ 13 years old, expanding the anus after the anus a week of sewing 6 ~ 8 traction line suture fixed to the homemade anus ring on the hook, can be fully exposed to the anal canal and fistula orifices, the transverse shuttle incision of the fistula mucosa, excision of the mucosa and scar tissue within the fistula, suture closure of fistulas, fan free fistula proximal mucosa and the distal mucosa of fistulas. The proximal mucosa of the fan free fistula and the distal mucosa of the fistula were sutured in place. The first phase cured 19 cases, 1 case of postoperative recurrence, 3 cases of loss of visit, the average time of discharge was 3.5 days after surgery, no anal stenosis, fecal incontinence in the follow-up, the results were good. The application of homemade anal ring pull hook can significantly increase the anal canal and rectal exposure and improve the efficacy. Pediatric acquired rectal vestibular fistula refers to female infants born with normal anus, rectal vestibular fistula secondary to perineal infection, the more common anorectal disorders, pediatric rectal vestibular fistula, also known as female infantile rectal vestibular fistula, is a common congenital anorectal anomaly, rectal vestibular fistula traditional treatment methods are either traumatic, destroying the perineum, or the rectum, anal tube exposure difficulties, easy to recur. Our hospital has used modified transanal rectal vestibular fistula repair to treat 23 cases since December 2005~June 2012, and achieved good results. 1, DATA AND METHODS 1.1 Clinical data Since December 2005~June 2012, 23 cases of rectal vestibular fistulae (including 18 cases of rectal navicular fossa fistulae, 4 cases of rectal labial fistulae, and 1 case of rectovaginal fistulae) were admitted to our hospital in female infants, of which 18 cases had a clear history of postnatal perineal infection and were aged from 6 months to 13 years old. 1.2 Surgical methods A modified transanal repair of rectovaginal fistula in pediatric patients was used in all cases. Preoperative preparation: oral metronidazole and vitamin K tablets 3 days before surgery, clean enema in the evening and morning before surgery. Surgical points: tracheal intubation under general anesthesia, routine disinfection, toweling, double lower extremity sterile towel wrapped and fixed in the anesthesia frame in a modified lithotomy position, dilated anus rectum stuffed with complex iodine gauze, anus weekly sewing 6 to 8 traction line suture fixed to a homemade anal ring pull hook, can be sufficient to disclose the anal canal and fistula, the fistula mouth of the submucosal injection of 1:100000 epinephrine saline; the fistula as the center of the mouth of the fistula Transverse pike-shaped incision of the fistula mucosa, excision of the mucosa and scar tissue in the fistula tract, with a No. 1 or No. 4 silk thread transverse double suture closure of the fistula tract, fan-shaped free fistula proximal mucosa of about 1 ~ 2cm so that it can be tension-free drag down to cover the original fistula, and the fistula with the distal mucosa to the 4-0Dexon line of the opposing suture, anus inside the wrapped with Vaseline gauze thick rubber tubing, dressings and bandages. Postoperative application of antibiotics for 1-3 days, keep the perianal area clean, dry, after defecation with 1:5000 potassium permanganate sitz bath, infrared lamp bake 30min, without removing stitches. About one month after the operation, come to the hospital for rechecking, anal diagnosis to find out whether there is any rectoanal stenosis, and dilate the anus if necessary. 2.Results 20 cases of all 23 patients were followed up in outpatient clinic on a regular basis, and the average time of discharge was 3.5 days after the operation, 19 cases were cured in the first stage without anal stenosis or fecal incontinence, 1 case of recurrence of infection in the first week after the operation, and cured in the second operation 7 months after the infection was controlled, and the follow up was from 6 to 12 months, and there was no anal stenosis or fecal incontinence. 3, Discussion pediatric acquired rectal vestibular fistula, also known as female infantile rectal vestibular fistula, is a common pediatric anorectal malformation, some scholars believe that this disease is due to the congenital anatomical abnormality of the anorectum, easy to secondary infection. There are two types of rectal vestibular fistula, one is congenital anal atresia combined with rectal vestibular fistula, is not within the scope of this article, this section describes the anal appearance of normal rectal vestibular fistula; manifestation of the anus is normal in appearance, the formation of a fistula between the rectum and the vaginal vestibule, most of them are located in the vestibular navicular fossa, most of the fistulas are less than 0.5cm in diameter, there are feces from the fistula during evacuation of dilute stools, and perineal flushing. The traditional treatment of rectal vestibular fistula has fistulotomy, hanging line, etc., traumatic, destroying the perineal body, poor appearance. Transanal rectal vestibular fistula transanal repair is by Jiangxi Provincial Children’s Hospital Professor Xu Benyuan first reported in 1981, its advantages are: 1, the incision is located in the rectum, does not destroy the perineal body, cosmetic effect is good, does not affect the patient’s adult birth through the vagina; 2, the trauma is relatively small. The disadvantages are: the anal canal and the fistula opening is difficult to reveal, barely repair recurrence rate is high. We use homemade anal ring pull hook, can be evenly and fully open the anus, fully exposed anal canal and rectal fistula orifice, which is conducive to accurate resection of lesions and repair, reduce trauma, improve the cure rate. Transanal rectal urethral fistula repair surgery should be carried out before adequate intestinal preparation, not only to facilitate surgical operation and shorten the operation time, but also delay the postoperative defecation time, prevent postoperative incision infection, and promote the role of postoperative recovery. In addition, perianal care should be strengthened after the operation to keep the incision clean and dry, to avoid infection caused by stagnant feces into the incision, which may lead to recurrence.