Fecal incontinence is still a frequent postoperative sequelae in dealing with high rectal anomalies. Posterior sagittal anorectoplasty (PSARP) has been previously used in 87 cases as a primary procedure and allows full exposure of the anorectal region. Through this approach, full understanding of the anatomic damage is obtained and consequently a rational reconstructive plan can be designed in each case. Eight patients were operated on using this approach as a secondary operation. Surgical findings included anteriorly placed anus in all cases, a laterally misplaced anus in one of them, different degree of levator destruction in all of them, a missed portion of levator muscle anterior to the rectum and posterior to the urethra in one case, and variable degrees of megarectum in all cases. Reconstruction included tapering and replacement of the rectum and anus to surround them by striated muscle, reconstruction of levator mechanism, and repair of a persistent cloaca in one case. Postoperative assessment included a clinical as well as manometric and radiological evaluation. There were excellent results in five patients. Three patients showed significant improvement, including one patient with no sacrum.