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Objective To evaluate the clinical efficacy and prognosis of neonatal primary anoplasty through a retrospective comparison of the results of defecation function and anorectal manometry after one-stage anoplasty. Methods From January 2006 to August 2019,a total of 132 children with intermediate anorectal malformation were recruited as study subjects. All of them underwent modified posterior sagittal anorectoplasty (mini-Peña).According to operative period, they were divided into two groups. Group 1 included 22 children diagnosed with intermediate anorectal malformation during neonatal period undergoing primary anoplasty. And group 2 had 110 children undergoing traditional staged anoplasty. Both groups were followed up for 15 years to evaluate long-term defecation functions and complications. During follow-ups, Rintala score was employed for evaluating postoperative defecation function and the grades were excellent, good, moderate and poor. All cases were examined by anorectal manometry, including anal resting pressure, anal length, internal sphincter resting pressure and length, external sphincter resting pressure and length and rectoanal inhibitory reflex (RAIR),etc. Results No significant inter-group differences in gender ratio or birth weight (P>0.05).Duration of postoperative hospital stay was longer in group 1 than that in group 2[(17.1±3.9) vs.(10.4±3.4) d, P<0.05].Hospital stay and operative duration were markedly shorter in group 1 than those in group 2[(19.6±5.5) vs.(37.5±10.7) days;(128.9±29.0) vs.(287.9±61.2) min, P<0.05].No significant inter-group difference existed in anal length or internal/external sphincter length(P>0.05).Anal resting pressure, internal sphincter resting pressure and external sphincter resting pressure of group 1 were higher than those in group 2[(53.8±15.5) vs.(36.7±10.4) mmHg;(53.5±15.1) vs.(34.6 ±8.7) mmHg;(45.7±16.9) vs.(33.9±11.8) mmHg, P<0.05].Extraction rate of rectal inhibitory reflex was significantly higher in group 1 than that in group 2 (66.7% vs.0%,P<0.05).No significant statistical difference existed in other anorectal pressures(P>0.05). Rintala score of two groups showed no obvious difference in rate of excellent/good(83.3% vs.88.0%,P>0.05).(83.3% vs.88.0%,P>0.05).No significant inter-group differences existed in the incidence of constipation, soiling or postoperative complications(25% vs.28.0%;16.7% vs.16.0%;33.3% vs.50.7%,P>0.05).Conclusion Neonates with intermediate anorectal malformations undergoing one-stage anoplasty can also have good postoperative stool control ability. Early one-stage anoplasty may avoid operative wound and closure of stoma. [ABSTRACT FROM AUTHOR]