Rectovaginal fistula repair surgery paths and modalities, each surgical paths and modalities may be successful, but may also lead to surgical failure, the main factors affecting the success of rectovaginal fistula repair intraoperative exposure, free, suture techniques. A good surgery starts with exposure, and unsatisfactory exposure often leads to failure or more serious complications. Freeing is done so that the rectal wall to be repaired is sutured without tension. Suture technique obviously plays a crucial role in the success of rectovaginal fistula repair. The advantages and disadvantages of various pathway procedures are discussed below. First, various surgical pathways for rectovaginal fistula repair 1, transanal pathway surgery Xue Qi, Department of General Surgery, Nanfang Hospital, Southern Medical University Purely transanal pathway surgery is not good exposure. The author’s experience is generally best not to use, but the transanal is a natural channel, can be used as a variety of repair surgery auxiliary pathway. 2, transvaginal pathway surgery Obstetrics and gynecology believe that the transvaginal pathway is convenient for exposure, and like to make repair surgery from the vaginal pathway. In the anterior wall of the rectum and the posterior wall of the vagina between the full free, can be used as a variety of repair and auxiliary pathway; 3, via the posterior anal sphincter pathway surgery (Mason surgery) The patient is placed in the prone position, from the anus to the caudal side of the posterior incision, incision of the skin and subcutaneous tissues, the posterior anal sphincter. Exposure is good, but more traumatic, not convenient to the rectal wall around the incision fully free, and there is a risk of postoperative rectal (or anal canal) skin fistula, the author does not favor the application. The author believes that the posterior anal sphincter pathway surgery (Mason surgery) is suitable for resection of masses around the lower rectum without incision of the rectal wall. 4, transperineal pathway repair a, transperineal transverse (or curved) incision caliber pathway between the anus and vaginal opening to make a transverse (or curved) incision, incision of the skin, subcutaneous tissue, to the depth of the anterior rectal wall and the posterior wall of the vagina between the separation until the fistula over the fistula above the fistula, the fistula clearing, will be the rectal wall wound to the whole layer of intermittent suture. Exposure (but not too high a free position) and suturing are favored. The author believes that transperineal repair is a good way to repair surgery, can also be used as a laparoscopic (or transabdominal) pathway repair of the joint pathway. b, transperineal longitudinal incision route between the anus and the vaginal opening to make a transperineal longitudinal incision, incision of the skin, subcutaneous tissue, incision of the perineal central tendon until the fistula above the posterior wall of the vagina and the anterior wall of the rectum, clear the fistula, intermittent suture, the reconstruction of the anal sphincter and the central tendon of the perineum. It facilitates surgical operations such as exposure and suturing, but does not facilitate adequate freeing. It is only suitable for rectovaginal fistula combined with anal sphincter injury caused by labor injury. 5, trans-laparoscopic (or trans-abdominal) pathway surgery The development of trans-laparoscopic pathway surgery, breaking the pattern of the traditional rectovaginal fistula repair surgery, to avoid the shortcomings of the above pathway is difficult to fully free, greatly conducive to the exposure and the full rectal wall of the full free. Second, the key to rectovaginal fistula repair surgery is to “maintain the seal of the inner tube. 1, like a bicycle tire that does not leak, the key is to have an intact inner tube, even if the outer tube is broken, it will not leak. If the inner tube is not intact, it is futile to strengthen the outer tube to repair it. In the author’s experience, even if the tissue flap transfer (to strengthen the outer tire repair) can not guarantee that the inner tire will be repaired, and may lead to unsuccessful repair surgery; in addition, the tissue flap transfer surgery is more traumatic, the author has rejected all kinds of tissue flap transfer techniques (such as femoral thin muscle transfer or labia majora subcutaneous tissue flap transfer surgery). The author does not advocate the use of weak rectal mucosal flaps (part of the rectal wall) that may lead to failure. The author advocates tension-free suturing of the entire rectal wall, which has a good blood supply, in order to improve the success rate of the procedure, i.e., emphasizing the “maintenance of the seal of the endobutton. 2. In order to achieve the above objectives, the author believes that, depending on the location of the rectovaginal fistula, rectovaginal fistula repair can be done by the transperineal route, or by the laparoscopic (or transabdominal) route, or by the laparoscopic (or transabdominal) route in combination with the transperineal route or by the laparoscopic (or transabdominal) modified Bacon procedure.