BACKGROUND Twenty-one patients who had simple rectovaginal fistulas were treated at the Surgical Department of "Tor Vergata" University from 1992 to 1996 all of whom were at the first approach. METHODS The fistulas were treated with complete excision of the external tract and primary closure of the internal opening with advancement of a rectal mucosal flap, distal to the origin fistulas opening. The vaginal side is left open for drainage. RESULTS Eighteen of the twenty-one patients had good results; three patients required reoperation for recurrences; all of them had satisfactory results. CONCLUSIONS The advancement flap technique was very useful for simple rectovaginal fistulas with any sphincter damage, and it is very well tolerated by patients.