Management of patients with high imperforate anus can be greatly facilitated using a laparoscopic-assisted approach,in which the patient is operated on in the supine position, and the rectum is mobilized down to the fistulous connection to the bladder neck. This fistulous connection is then divided, and the rectum is completely mobilized down to below the peritoneal reflection. The operation then proceeds at the perineum, and the location of the muscle complex is determined using the nerve stimulator. A Veress needle is then advanced through the skin at the indicated site, with the laparoscope providing guidance to the exact intrapelvic orientation. Dilators are then placed over the Veress needle, the rectum is pulled through this peritoneal opening, and an anoplasty is performed.