Aim: Despite the significant evolutions in the management of anorectal malformations (ARMs), there are a serious surgical and functional complications. The aim of this study was to evaluate the posterior sagittal anorectoplasty (PSARP) as a re-do operation in patients who failed/complicated initial repair of anorectal malformation

Methods: 17 patients (10 boys and 7 girls, age range from 4 months to 7 years) who had previous failed and/or unsatisfactory surgery for anorectal malformation underwent secondary operations through posterior sagittal approach. The main reasons of surgery were constipation in 7 boys, passing urine from the rectum in 3 boys. Regarding girls, 2 complete closure of the new anus, two girls were passing stool from the vagina and Last girl had complication of cloacal repair with vesico-vaginal fistula.

The primary surgery was anoplasty in 3 and PSARP in the rest. In 9 patients needed colostomy before the redo surgery and rest has colostomy before presented to IMC.

In boys' group, 3 had completely missed recto-bulbar fistula, which needed a full mobilization and classic repair of the fistula and dissection of the common wall. Three boys had complete transection of the urethra, needed formal redo and repair of the urethra. The last 4 patient had complete closure in 2 had narrow tack as cutaneous fistula in 2

In girls, two needed a redo of completely retracted rectum and closed anus, three needed redoes with repair of the iatrogenic recto-vaginal fistula of previously treated vestibular fistula and last two had completely disruption of previous surgery and retraction lifted with tiny cutaneous fistula

Result: Patients underwent follow up ranging from 6-18 months expect 4 (three still has a colostomy and colostomy closure one week ago). Anatomical repair of the defects was fulfilled in all of them. The 13 patients/family are satisfied with the functional result after the redo surgery compare to the pre-redo PSARP function.

Conclusion: Pre-operative diagnosis is very important and clear plan of surgery is mandatory. The serious complication happened due to misdiagnosis. A well-trained pediatric surgeon with urology training or in the presence of pediatric urology is mandatory to avoid this major complication