Abstract Introduction: Laparoscopically assisted anorectoplasty (LAARP) was introduced in 2000,1 and the number of hospitals adopting it for the treatment of high-type anorectal malformation (rectovesical or rectoprostatic fistula) is increasing. However, the application of LAARP for rectobulbar urethral fistula is controversial because precise division of the fistula in the deep pelvic cavity is difficult, and there is a potential risk of posterior urethral diverticulum.2–4 In this video, we introduce a novel procedure for an imperforate anus with a rectobulbar fistula involving precise ligation of the fistula and appropriate placement of the rectum in the center of the sphincter using combined laparoscopically assisted and anterior sagittal approaches. Case Report: A boy weighing 2220 g was born at a gestational age of 37 weeks and diagnosed with an imperforate anus immediately after birth. No associated malformations, including neurological abnormalities and sacral deformities, were noted. Initially, a...