Background: The aim of this study is to assess the feasibility, safety, and the outcome of one-stage repair of high and intermediate anorectal malformation in a neonate by posterior sagittal aneorectoplasty (PSARP) compared to the three-stage procedure. Methods: The study comprised fifty patients Classified into two groups, with 25 patients in each group. Group A patients were managed by one-stage procedure (posterior sagittal anorectoplasty) in early neonatal life. Group B pateints were managed by traditional three-stages procedure (colostomy- posterior sagittal anorectoplasty- colostomy closure). Follow up for continence was from parents history and examination. MRI and/or CT for sphincter position and function were done in selected cases. Postoperative grading of continence was done according to the following criteria: Grade A: Clean, Grade B: Soiling and Grade C: Fecal matter.   Results: Complications were encountered in 4 (16%) patients in group A, and 6 (24%) patients in group B. (Group A: 13 52%) patients were classified as good, 11 (44%) as moderate, and one (4%) - (male with rectobulbar fistula) - as poor. Group B: 10 (40%) patients were classified as good, 13 (52%) as moderate, and 2 (8%) -¬¬¬ (female with rectovaginal fistula and male with rectovesical fistula) – as poor. Conclusion: We found it is safe and feasible to do one-stage procedure for anorectal malformations, with higher or at least similar outcome. Keywords: early PSARP, one stage, early neonate, (1) Benha faculty of medicine, Surgery department. (2) Cairo faculty of medicine , Pediatric surgery department.