Introduction: High Anorectal malformations (ARM) surgical management includes Initial colostomy at neonatal period followed by Abdominoperineal posterior sagittal anorectoplasty (PSARP) without a protective colostomy. This study compared between results of these cases and those done in Classical abdominoperineal PSARP with protective colostomy and recognizes the disadvantages and complications, if any. Material and methods: A Total of 30 Patients was studied. 15 Patients with classical Abdominoperineal posterior sagittal anorectoplasty (PSARP) with protective colostomy (3 Stage) constituting Group A studied retrospectively & 15 Patients were studied in Group B who underwent neonatal colostomy followed by Abdominoperineal PSARP without protective colostomy (2 Stage). Comparative study was done between the 2 groups for a better choice procedure for High ARM patients. Results: In group A, blood transfusion required was more than Group B. Mean expense incurred in group A was more than group B. Complications in group A occur in 8 patients whereas in group B, complications occurred in 6 patients. Conclusion: Two stages repair of high ARM and pouch colon is better alternative to three stages repair in all aspect.