Purpose: This study aimed to evaluate the mid-term functional and cosmetic outcomes of perineal body–sparing trans-sphincteric anorectoplasty (TSARP) in patients with anal atresia and  rectovestibular fistula.  Methods: Patients with anal atresia and rectovestibular fistula who underwent perineal body–sparing TSARP between 2018 and 2024 were retrospectively reviewed. All procedures were performed by a single pediatric surgeon. Demographic data, presence of colostomy, perioperative complications, postoperative first-feeding time, and functional outcomes were recorded. Functional outcomes in patients were assessed using the Krickenbeck classification.  Results:Twenty-six patients underwent perineal body–sparing TSARP. One-stage repair was performed in 16 patients (61.5%), whereas 10 (38.5%) had a protective colostomy. The median age at operation was 40 days (range 2 days–7 months). Posterior vaginal wall injury occurred in two patients and was repaired uneventfully. Two patients developed wound infection that resolved with local wound care. The mean follow-up period was 3.25 years. Among 18 patients older than 3 years, voluntary bowel control was present in 15 patients (83.3%). Constipation occurred in seven patients, and no patient developed soiling.  Conclusion: Perineal body–sparing TSARP appears to be a safe and effective technique for rectovestibular fistula, providing low complication rates with satisfactory functional and cosmetic outcomes.