Background/Purpose: This study summarizes the surgical treatment options and their clinical efficacy for postoperative residual rectourethral fistula following anoplasty in patients treated in our department from July 2005 to July 2012. Methods: For 38 cases of postoperative residual rectourethral fistula following anoplasty, according to differences in anal appearance and functionality, either an anterior sagittal or a posterior sagittal surgical rectourethral fistula repair procedure was performed. Results: The residual rectourethral fistula following anoplasty was an obvious tube-like structure with a length of 0.9 +/- 0.4 cm. Healing after the 1-stage operation was achieved in 37 cases. Among these cases, 35 were followed up and showed no urethral stricture and no diverticulum. The clinical score for anal function was excellent in 31 cases and good in 4 cases, with significant differences compared with the scores before surgery (P < 0.05). The respective operative times for the 2 surgical procedures were 74.6 +/- 10.1 minutes and 105.6 +/- 14.6 minutes (P < 0.05). Conclusions: The appropriate choice of surgical procedure was dependent on the patients' anal appearance and functionality. Posterior sagittal anorectoplasty was suitable in cases with a severely disordered perineal appearance, and it was a relatively difficult operation. In contrast, anterior sagittal anorectoplasty was best applied in patients with minor alteration in perineal appearance, and it had a clear surgical field and was easy to perform. In this study, the repair of cases of residual rectourethral fistula following anoplasty using anterior sagittal or posterior sagittal anorectoplasty showed high success rates, and anal function was significantly improved.