Background <p>This study aims to investigate the impact of early versus delayed repair on early postoperative complications and midterm and long-term bowel function in ARM patients with rectoperineal fistula.</p> Methods <p>A total of 568 ARM patients with rectoperineal fistula who underwent cutback anoplasty were identified at our hospital from 2015 to 2021. Early repair was defined as an anoplasty performed at or before 28&#xa0;days of age. Delayed repair was defined as occurring after this period.</p> Results <p>267 patients were finally enrolled, with 171 males and 96 females. 129 (48.3%) underwent early repair and 138 (51.7%) delayed repair. Early postoperative complication rates showed no significant difference between the two groups (0% vs. 0.7%, <i>P = </i>1.000). No wound infections or dehiscence occurred in either group within 6&#xa0;months postoperatively. The median Rintala score did not differ significantly between the early and delayed groups (20 vs. 20, <i>P = </i>0.272). Based on the Krickenbeck classification, there were no significant differences between the groups regarding constipation, soiling, or voluntary bowel movements (<i>P &gt; </i>0.05).</p> Conclusions <p>Early and delayed repair have no significant impact on early postoperative complications and midterm and long-term bowel function in ARM patients with rectoperineal fistula. Neonatal cutback anoplasty is safe and effective for stable patients without major comorbidities, offering a favorable prognosis.</p> Graphical abstract <p></p>