Postirradiation [for intrapelvic cancer] rectovaginal fistulas are notoriously difficult to repair, as are the strictures that are usually associated with them. Previous attempts have involved resection and low anastomosis by various techniques. Patients considered not suitable for resection were treated by permanent fecal diversion. A technique of repair not previously reported is described. It relies on the proximal part of the colon as a vascular pedicle graft, used as a patch to close the rectal defect and to provide circumference to relieve any associated stricture. Five patients are reported in whom complicated fistulas and strictures have been corrected with restoration of normal rectal function.