Neonatal management of patients with anorectal malformations.

PURPOSE OF REVIEW: To synthesize current practice patterns, expert consensus, and evidence-informed recommendations for the evaluation and management of patients with anorectal malformations (ARMs).

RECENT FINDINGS: Adoption of standardized, anatomy-based classification systems has improved consistency in reporting and enabled more robust multiinstitutional research. Increasing centralization of care within multidisciplinary colorectal centers has enhanced coordinated evaluation across multiple surgical subspecialties. Early, comprehensive screening for associated anomalies - particularly renal, spinal, and Müllerian abnormalities - remains critical, though gaps in detection persist. Initial management strategies emphasize ensuring effective bowel decompression through dilation, diversion, or selective primary repair. Surgical management continues to evolve, with growing evidence supporting selective single-stage repair in low malformations and utilization of emerging techniques aimed at minimizing morbidity while preserving function. Contemporary data highlights the importance of risk-stratified, longitudinal urologic surveillance given the high prevalence of renal and bladder dysfunction, particularly in patients with high fistula insertion or persistent cloaca, upper urinary tract anomalies and/or clinically significant spinal dysraphism.

SUMMARY: Optimal neonatal management of ARM includes comprehensive screening for associated anomalies, early multidisciplinary involvement, and individualized decision-making regarding timing and approach to repair, ideally within experienced, high-volume centers.