Transanal approach has been slightly changed from Rothenberger’s (1982); however it is almost the same [18]. Local repair or advancement ap operation is adequate surgical method for low­type RVF without sphincter damage or inconti­nence. Fistula opening in the anus can be the consistent cause of infection, and with pressure being high in the anus, transanal approach has advantage of direct access to the opening of the anus where the pressure is high. But the surgical view is not as great as the transvaginal approach. The success rate is around 70–80% [10, 17, 19], but in the case of recurrent RVF, the rate is lower [10, 20–22]. It is not usual to consider fecal diver­sion prior to the operation. Main causes of failure are ap retraction and ap necrosis. Therefore, it is important to design ap including the inner cir­cular muscle and have sufcient dissection and have the width of base of ap be twice that of the apex for smooth blood circulation. Local suture method requires sufcient dissection of sur­rounding tissue to reduce tension during suturing and, overlap suture the rectum and vaginal suture line to strengthen the suture area. In some advancement ap operation, it is reported to have incontinence [19, 23], but this is affected by the condition of sphincter prior to the surgery. Therefore it is important to examine sphincter function through anal physiology test prior to the surgery. The success rate of advancement ap operation when done primarily is high as 88–95% [24, 25], but in the case of recurrent surgery, the rate is lower [10].