Purpose Rectal atresia (RA) and rectal stenosis (RS) are rare anorectal malformations (ARM), comprising 1–2% of all cases. No consensus exists regarding optimal surgical technique. This study evaluated surgical approaches, complications, and long-term functional outcomes at a single referral center.Methods Retrospective review of patients with RA or RS treated between 2003 and 2020. Surgical technique, complications, and bowel function were analyzed. Fecal continence was assessed using the Krickenbeck classification in patients older than 3 years with minimum 6-month follow-up after colostomy closure.Results Eleven patients were included (7 RS, 4 RA), representing 1.2% of 900 ARM cases. Surgical approaches included posterior sagittal anorectoplasty (PSARP) in 4 (36.4%), transanal in 4 (36.4%), abdominoperineal pull-through in 1 (9.1%), and laparoscopic endorectal technique in 2 (18.2%). Two patients required redo surgery. Of 9 eligible for functional assessment, 6 (66.7%) achieved fecal continence, 3 without additional treatment. Three had constipation and soiling due to poor adherence. Median follow-up was 100.4 months (range 13–168).Conclusion Despite surgical complexity, most patients achieved satisfactory outcomes. The high incidence of constipation, particularly in RS, underscores the need for long-term follow-up and early intervention. The laparoscopic endorectal technique offers a reproducible, sphincter-preserving approach to rectal web correction.