ABSTRACT
A careful perineal inspection gives clues to the type of malformation present. It is important to not make any decisions regarding the anatomic diagnosis and the surgical management before 24 hours of life due to the fact that significant intraluminal pressure is required for the meconium to be forced through a fistulous tract, which helps to establish the diagnosis. A vestibular fistula is the most common finding in females. Good bladder emptying confirmed by ultrasound, absence of hydronephrosis and confirmation of good renal function are key factors to follow, ideally in collaboration with paediatric urology. Protection of the repair from wound complications is an advantage of a colostomy and it allows for a distal colostogram, which when done correctly gives the surgeon vital information as to where the rectum will be found. The upper sigmoid divided colostomy has very clear advantages over a right or transverse colostomy.
