Objective: To explore the causes of rectal injuries during laparoscopic peritoneal vaginoplasty (Luohu operation) and assess measures that can be taken to increase safety of the operation. Materials and Methods: Data of patients with rectal injuries that occurred during Luohu vaginoplasty were analyzed retrospectively. Results: Three hundred and six patients received Luohu vaginoplasty. Rectal injuries occurred in 13 patients (4.2%). All patients recovered after intraoperative repair or postoperative rectovaginal fistula repair, performed within three to six months. Full display of the anatomical structures at the bottom of the pelvic cavity and successfulconstruction of the vaginal tunnel are the two most important requirements for reducing the risk of rectal injury in laparoscopic vaginoplasty. In repair of fistulae postoperatively, it is important that resection of tissues or scars around the fistulae be avoided in order to reduce the chance of a injuries caused by diverting colostomy or colostomy closure. Conclusion: Laparoscopic vaginoplasty is a generally safe procedure, but rectal injury can occur. Retaining the tissues or scars around the rectovaginal fistula can be successfully repaired, either when they are recognized during the operation or within a few months postoperatively.