Experience with 89 cases of imperforate anus treated at Charity Hospital of New Orleans and the Ochsner Clinic has emphasized the importance of more standardized management of this anomaly. The importance of the observation period in determining the best plan of treatment has been stressed. Imperforate anus has been classified into four types. The surgical procedure to be employed depends on the type of anomaly, the associated anomalies and the degree of surgical risk. For type I digital dilation is usually sufficient except in cases of hard fibrotic rings when anoplasty may be required. An intrasphincteric procedure should be performed for type II anomalies. In patients with type III anomalies in which the distance between the rectal pouch and surface of the skin exceeds 1.5 cm., in those with rectovesical, recto-urethral or rectovaginal fistulas above the hymen and in those with type IV anomalies, the abdomino-intrasphincteric pull-through procedure is recommended. The anal sphincter-preserving operation is the procedure of choice for rectovaginal fistulas that open below the hymen into the fossa navicularis and for all rectoperineal fistulas. The success of immediate definitive treatment depends upon the skill of the surgeon, and the presence or absence of prematurity and associated anomalies. The various surgical technics have been described.