Purpose Despite advances in the treatment of Crohn’s disease, the treatment of rectovaginal fistulas remains challenging. Rectal (RAF) and vaginal advancement flaps (VAF) represent two possible alternative surgical approaches to this problem. The study aims to review results of these surgical procedures for rectovaginal fistulas in Crohn’s disease.Methods: Medical databases from 1975 till August 2008 were consulted for potentially relevant publications. All studies dealing with the rectovaginal fistula repair in CD with rectal or vaginal advancement flaps were included. Two researchers worked independently on the study selection, quality assessment, data extraction and analysis phases of the study. Analyses were performed with Review Manager 2.0 softwareResults Eleven observational studies were included with a total of 219 flap procedures for RV fistula:. Primary fistula closure pooled rate was 54.2% (range 33.3-100%) after RAF and 69.4% (range 0-92.9%) after VAF (p=0.13). Four studies were eligible for proper metanalysis. In 56 patients the relative risk of primary fistula closure of RAF compared to VAF was 1.04(95% CI: 0.63-1.72). After 79 procedures the relative risk of overall success of RAF compared to VAF was 0.92 (95% CI: 0.58-1.45) (Figure 1). The relative risk of recurrence after RAF compared to VAF was 0.47 (95% CI: 0.15-1.46)(Figure 2); in this case only two studies were taken into consideration.Conclusions Although limited by a few number of studies of low clinical evidence level, this systematic review suggests that there is no significant difference in terms of outcome between RAF and VAF for rectovaginal fistulas in Crohn’s disease. Recurrence rates seem to be lower after RAF but only two studies were available for metanalysis.