The minimally invasive approach to the repair of congenital malformation is here to stay. All of us, pediatric surgeons, are concerned about inflicting pain and/or being too invasive to our patients. Every effort aimed to reduce the suffering of our patients, as well as the length of stay in the hospital and subsequently the cost of the operations, is welcomed. We embrace ideas that have, as the end result, a less traumatic operation without compromising the standard of care or provoking more sequelae in our patients. That explains why the minimally invasive approach to repair malformations had so much impact in pediatric surgery and the surgical field in general.

Since the introduction of this new technology, there are now operations in which the laparoscopic or thoracoscopic approach represents the gold standard. There are others in which these new approaches have not been applied, and there is another group in which the approach is controversial. Anorectal malformations have not been an exception, and many pediatric surgeons have used and continue trying to use more and more the laparoscopic approach to the repair of anorectal malformations, many of them with the correct indication, others in malformations that can be repaired either way laparoscopically or posterior sagittally, and others in cases in whom we believe that laparoscopy is formally contraindicated.

Our basic contention and belief is that laparoscopy is primarily indicated to replace a laparotomy. In other words, a classic indication is a procedure that is usually done opening the abdomen and now can be done equally well, through the small orifices of the ports necessary for minimally invasive operation. In male patients with anorectal malformations, we have to open the abdomen 10 % of the times, specifically in those cases that have a recto-bladder neck fistula. We consider that group a good potential indication for laparoscopy. We use the word “potential” because even in those particular types of defects, laparoscopy has certain limitations, as will be shown later.

Approximately 30 % of patients with cloacas require a laparotomy. Yet, all of them require a posterior approach in order to repair the urogenital component of the malformation. Conceivably, a laparoscopic approach could be useful to separate the rectum from the bladder neck in those unusual cases that have the rectum connected to the bladder neck. Yet, those patients require rather sophisticated and technically demanding maneuvers to repair the urogenital component of the malformation (see Chap.​ 16).

We decided to review the literature related with the laparoscopic approach of anorectal malformations. We found 52 papers published between 1998 and 2014. Forty-one of them [1–41] presented series of cases (Table 13.1). Ten papers [42–52] were rather informative, written by experts but without discussing specific cases.