Of 174 patients with anorectal malformations, among them 71 children with high atresia, 59 patients could be followed-up. 57% were entirely incontinent according to electromanometrical findings. These patients necessarily needed sphincter-replacement operations to improve the function of the sphincter-apparatus. Eighty-one sphincter-replacement operations were performed in 68 patients, among them 56 gracilis transplantations, 12 palmaris-longus transplantations, and 4 stalked smooth muscle transplantations. All sphincter replacement operations improved continence considerably.