PURPOSE: deVries and Pena in 1982, reported posterior sagittal anorectoplasty (PSARP) as an operative procedure for a high or intermediate imperforate anus (IA). PSARP has gained overall acceptance as a standard operative method for the repair of high and intermediate anorectal malformations. However, reports concerning the long-term outcomes of patients who have undergone a PSARP are still quite few. METHOD: To evaluate the quality of life for IA patients after a PSARP, 26 out of 43 patients who had undergone a PSARP were evaluated by using a questionnaire more than 10 years after closure of colos tomy. The questionnaire was composed of 5 categories; defecation patterns, defecation aids, social life, satisfaction, and problems after the PSARP. RESULTS: There were 23 males and 3 females. Ages were 13-26 years old. There were 17 rectourethral fistulae, 3 rectovesical fistulae, one rectal atresia, one rectovestibular fistula, and 2 rectovaginal fistulae. Follow-up periods were 12-16 years. For defecation patterns, normal defecation was observed in 62% of the patients, accidental soiling in 23%, and continuous soiling in 15%. For defecation aids, 54% of the patients used no defecation aids, 38% used enemas, and 8% used laxatives. In social life, 69% of the patients had no problems, 23% missed school, and 8% missed camp or a trip. As to the patients' own satisfaction, 81% wanted no reoperation and 19% wanted a reoperation. Problems after PSARP were reoperations for an anal transposition in 4 patients and a urethral stricture in one. CONCLUSION: PSARP resulted in good bowel control and satisfaction in the majority of IA patients, but some patients needed supportive measures and wanted a reoperation, if possible.