Rectovaginal fistulas of the middle and lower vagina can be managed with an advancement flap of rectal mucosa and circular muscle. The new mucosa is advanced over the rectal opening to cover the high pressure aspect of the fistula. Underlying sphincter defects can be corrected concomitantly. Fistulas due to obstetric injury, cryptoglandular disease, and Crohn's disease are treated in this manner.