Between 1962 and 1987, 434 patients with anorectal (AR) malformations underwent operations at the hospital for sick children in Cologne. On the basis of continence results from these patients, the influence of the primary operation on postoperative anorectal continence is discussed. It can be concluded that a number of operations used in earlier times such as the cut-back procedure, the primary or secondary abdominoperineal pull-through procedure, should not be used with the advent of more detailed and sophisticated radiologic investigations and never anatomyrelated surgical techniques, AR continence results can be improved. The anatomical principles of these primary procedures are discussed.