ABSTRACT
Total proctocolectomy with end ileostomy was for many years the procedureof choice for inflammatory bowel disease (IBD) patients who required surgery.However, additional options have evolved over the past 40 years, including colectomy with ileorectal anastomosis (which should generally only be used in patients with rectal sparing), restorative proctocolectomy with continent ileostomy, or reconstruction with an ileal pouch-anal anastomosis (IPAA). The latter has become the most frequently performed procedure for patients with ulcerative colitis (UC) who require surgery. Total proctocolectomy was initially conceived as a four-stage procedure (ileostomy, right hemicolectomy, left hemicolectomy, and abdominoperineal resection) eventually becoming a two-stage procedure (total abdominal colectomy and proctectomy) and, finally, the modern one-stage procedure due to advances in anesthesia, antibiotics, and surgical technique.
