Rectovaginal fistula (RVF) is a rare but dangerous condition in anorectology and obstetrics and gynecology, with the main clinical manifestation being vaginal defecation and, in severe cases, uncontrolled stool. It is usually not self-healing and requires surgical intervention. Due to the complex etiology and variety of RVF and the high rate of postoperative infection and recurrence, reoperation is difficult. Depending on the size, location, and etiology of the fistula, a variety of treatment modalities are available. Etiology: The first cause of RVF is birth injury, followed by infection (bacterial and lymphogranuloma), malignancy, especially surgical trauma supplemented by radiotherapy and hysterectomy, inflammatory bowel disease and others. Classification: RVF is currently classified internationally as simple or complex by the size, location and etiology of the fistula. The size of the fistula is defined as 2.5 cm. There are three types of location: high, medium and low. High is when the vaginal side of the fistula is at or above the cervical level; low is when the rectal side of the fistula is at or below the dentate line and the vaginal side is at or below the labial ligament; and medium is somewhere in between. Generally, fistulas larger than 2.5 cm, high and caused by inflammatory bowel disease and recurrent RVF are complicated, while the rest are simple. Diagnosis: RVF is relatively easy to diagnose, and the diagnosis is usually made based on clinical symptoms. 1, careful medical history to exclude fistula caused by inflammatory bowel disease. Physical examination: rectal and vaginal finger examination can clarify the location of the fistula, and the tissue around the fistula can be examined, such as the presence or absence of scars. 3. Adjunctive examinations: Transrectal or transvaginal endoluminal ultrasound is appropriate for low to moderate RVF, while MRI is more appropriate for high level patients with RVF. Treatment: RVF usually requires surgical cure. Surgical treatment requires a preparatory process and medication is usually recommended for 3-6 months to control local inflammation, etc. A small number of patients will even heal spontaneously during this time. Surgical repair of RVF is varied, with some requiring cecal diversion, transvaginal repair, transrectal repair, transperineal repair, transabdominal repair, patch repair, self-tissue repair, and even laparoscopic repair of high fistulas. The surgical approach, access and repair material are determined by the size and location of the fistula, the etiology and whether the fistula is recurrent. 1. For simple RVF transrectal flap advancement is a more popular treatment by anorectal surgeons. The key is to remove and close the rectal side of the RVF while covering the high pressure side with a mucosal loop with a good blood supply. To maintain the integrity of the anterior rectal wall, the parafistula tissue should be adequately freed, the surrounding tissue level should be carefully identified, and the fistula and surrounding scar should be completely excised. After cautious hemostasis, tension-free sutures should be performed to cover the rectal mucosal loops with good blood supply and maintain adequate blood supply between tissues in order to repair the RVF. 2. For complex fistulas Fecal diversion, openness to the fistula and reduction of inflammation at the fistula is the key to repair. The experience of ZJUH uses a double-lumen stoma of the colon or ileum. There are more methods of repair, such as large omental filling, thin femoral muscle transloop, using intestinal plasma muscle lamellae with vascular tips, and rectal advancement flap technique can be effective. The key to repair is to separate the adhesions between the intestine and the vagina, repair the intestine and the vagina separately, and make sure to fill in the tissue loops with vascular tissues after the repair to avoid the recurrence of RVF by re-adhesions between the intestine and the vagina after the repair. 3.Congenital RVF is associated with congenital anorectal malformation, so only transabdominal surgery can be performed to free the rectal stump plus anoplasty. For congenital RVF, we believe that the rectovaginal septum should be separated first, the rectum and vaginal wall around the fistula should be fully dissected and freed during surgery, the blind end of the rectum should be fully freed, the puborectal muscle ring should be clearly exposed, the scar tissue around the fistula should be completely excised so that the defective part of the rectum and vaginal wall is in a tension-free state, and the defective suture repair of the rectum and vagina should be sutured with absorbable sutures respectively, which can make the fistula good healing can be obtained. 4. For RVF due to inflammatory bowel disease Local repair of RVF is likely to be successful when the disease is controlled by medication and stabilized, but there is still a high recurrence rate and nearly half of the patients with recurrent fistulas require further surgical treatment. In conclusion, RVF is a painful disease that causes great emotional stress to the patient and also poses a great challenge to the surgeon to choose the right timing and modality of surgery according to the location, size, and etiology of the RVF in order to completely cure it.