Udefiagbon et al, highlight the problems with a colostomy, particularly in a low income setting: skin excoriation, wound infection, sepsis, prolapse, fluid and electrolyte losses and poor acceptance by care givers. They present impressive outcomes for primary PSARP undertaken during the first week of life. Authors advocate the benefits of reduced infection rate due to the sterile nature of the meconium and avoidance of a prolonged 3-stage procedure, which is more expensive and often unfeasible for African families. However, this practice requires safe neonatal anaesthesia, skilled surgeons and good standards of peri-operative care. Olivieri et al have described a modified PSARP technique utilised in Eritrea to reduce the risk of perianal wound infection where they leave a 3cm rectal stump, which is trimmed after 2 weeks. Poenaru et al advocate performing a wider anoplasty, which is less prone to stenosis, as regular dilatation and following-up can be challenging in this context.