Anorectal anomalies present with a spectrum of defects; on the “good” side of the spectrum, we see patients with minor malformations that require minimal treatment with excellent results; on the other extreme of the spectrum, we find cases with complex defects, which represent a serious technical challenge and for whom the results in terms of bowel, urinary, and sexual function are not good despite accurate anatomic reconstruction. A newborn with an anorectal malformation may represent a surgical emergency related to intestinal obstruction and (or) due to severe associated urologic, gastrointestinal, or cardiac defects, which may require aggressive and efficient management. Other patients with these defects do not represent an emergency, because they have a fistula that allows intestinal decompression and they are born without serious associated abnormalities. In these cases, the repair of the defect can become an elective procedure or, if the baby is in good condition, can be definitively managed in the newborn period.