The management of RVF depends on size, location, and cause; anal sphincter function and overall health status of the patient; and the skill and judgment of the surgeon. Careful preoperative assessment of the fistula, surrounding tissues, and anal sphincter and exclusion of associated disease are essential. With thorough evaluation, thoughtful consideration of treatment options, and meticulous operative technique, patients can be assured of an optimal outcome. Success in treatment of patients with RVF should be measured not just in terms of successful closure of the fistula but also in terms of patient satisfaction with postoperative anal continence.