49 patients with continence-improving operations were reviewed. 41 children underwent a gracilis-transplantation according to Pickrell, 6 patients a free muscle transplantation according to Hakelius/Grotte and 2 patients a smooth muscle graft according to Schmidt. The clinical and manometrical results were compared with data from the literature. Furthermore a new technique of smooth muscle transplantation in the young infant is described. During an abdomino-sacroperineal pull-through procedure a flapped smooth muscle transplantation is performed simultaneously. The circular and longitudinal muscle layer of the pulled-through colon will be turned back and is fixed on the serosa under light tension. Afterwards the whole muscle cuff is repulled into the puborectalis sling. Examinations of the anorectal pressure as well as X-ray investigations showed a good function of the newly-established internal anal sphincter equivalent.