Abstract: There is no consensus among pediatricians and pediatric surgeons - on issues of early recognition of anorectal malformations and VACTERL abnormalities, preoperative management and methods of primary surgical correction; this in turn leads to the fact that many medical practitioners make a large number of diagnostic and technical errors. Which inevitably leads to unreasonable and redo operations, early disability and a decrease in the quality of life. Atresia is the absence of the anus, anal canal and rectal lumen. With so called “low form” of atresia, the blind end of the bowel is directly under the skin, and with “high form” at 1.5-2 cm higher. In this case, the rectus which has not descended can be communicated by fistula with neighboring organs. Recognition of atresia itself is not simple: with an external examination, the absence of the anus and the release of meconium through the anus, the presence of fistula. The picture of anorectal abnormalities varies depending on the type of defect and the presence or absence of combined defects and multiple defects. Depending on the “clinical dominant” of one or another concomitant pathology, the child was sent to the appropriate specialist. In some cases, in relation to the revealed lesions of the anorectal zone, it was necessary to adhere to expectant tactics in relation to the planned operation. This is what happened if information about a particular nosological unit made it possible, in general terms, to predict a not always positive outcome of the operation, and aggravating moments were also present.