No single major procedure is able to achieve all necessary goals without problems in the treatment of anorectal malformations. The Mollard-Pena (MOPE) procedure adds the benefits of an anoplasty based on the original perineal flap described by Mollard, but slightly modified, and the precise recognition of all muscle structures as reported by Pena and De Vries. Cosmetic as well as functional early results are encouraging.