The abnormal structural anatomy in anorectal malformations (ARM), commonly termed as “imperforate anus,” has been well studied in recent times and is now better understood; however, although a broad consensus exists, the optimal surgical management of ARM is still evolving. ARM can be isolated or part of the VACTERL association. Traditionally they are classified as “high” or “low” anomalies with the implications for difference in their management. A consensus classification encompasses them into a. major clinical groups depending on the anatomy of the malformations and, b. rare/regional variants. Posterior sagittal anorectoplasty is the most common surgical approach for reconstruction.