Purpose <p>Our institution introduced a laparoscopic approach based on laparoscopy-assisted anorectoplasty (LAARP) to treat persistent cloaca (PC). This study aimed to describe our technique and evaluate its outcomes in comparison with those of previous approaches.</p> Methods <p>We retrospectively analyzed 20 pediatric patients with PC who underwent anorectoplasty at our institution between January 2009 and September 2024. Rectal mobilization and anorectoplasty have previously been performed using the conventional transabdominal and/or posterior sagittal approaches. Laparoscopic rectal mobilization and fistula division using LAARP was introduced in 2016. Patients treated using these methods were divided into conventional and laparoscopic groups and analyzed.</p> Results <p>No significant differences in the clinical data were observed between the two groups, except for body weight. Similarly, no significant differences were observed in the surgical data. The postoperative follow-up duration was insufficient to adequately evaluate fecal incontinence. No intraoperative complications were observed in the laparoscopic group.</p> Conclusions <p>To the best of our knowledge, this is the first study to compare laparoscopic and conventional approaches for treating PC at a single institution. Despite these limitations, our findings suggest that the laparoscopic approach may be safer than the conventional approach for PC repair with a lower risk of intraoperative vaginal injury.</p>