Twenty patients with rectovaginal fistulas involving the middle portion of the rectovaginal septum were repaired without failure. The transanal approach would appear to be superior since it allows better access to the rectum which is the high pressure side of this fistula. This technique gives excellent results in benign rectovaginal fistulas occurring within 6 centimeters of the dentate line. The transanal approach also allows for the correction of any concomitant anorectal pathology which might compromise the repair. It is not to be used in instances of inflammatory disease or postradiation carcinoma.