ABSTRACT
Anorectal malformations have been treated in a rather empirical way; most surgeons performed a perineal anoplasty without a colostomy for low malformations. A colostomy was performed during the newborn period, followed by an abdominoperineal pullthrough for the treatment of those defects in which the rectum was found to be very high in the pelvis. A descending colostomy with separated stomas best fulfills the requirements necessary for the management of anorectal malformations, since it provides bowel decompression and protection. All anorectal malformations can be corrected by the posterior sagittal approach. The incision is midsagittal and its size changes depending on the specific type of defect. The most frequent malformation seen in males is imperforate anus with rectourethral fistula; in females, rectovestibular fistula. Two important decisions during the initial management of a newborn patient with imperforate anus are opening a colostomy and detecting and treating an associated urologic defect.
