A significant amount of new information has been obtained concerning the early management of anorectal malformations. The surgical approach also has changed and improved the functional prognosis of children with these defects. Recommendations are made based on a series of 632 cases. A simplified approach to avoid the most common errors in the management of these defects is emphasized. Yet, there are still many children born with severe anatomic deficiencies who cannot expect normal bowel function; however, for this group, a bowel management program is available to help improve their quality of life.