Ulcerative colitis

Abstract Surgery plays an important role in the multidisciplinary care of ulcerative colitis as resection of the colon and rectum cures their symptoms. Reconstructive endpoints after resection of the colon and rectum, are conventional end ileostomy, continent ileostomy, or ileal pouch anal anastomosis (IPAA), of which IPAA is the gold standard. We describe a three-stage procedure for IPAA with total abdominal colectomy with end ileostomy as stage 1, proctectomy IPAA with loop ileostomy creation as stage 2, and hand-sewn ileostomy as stage 3. If after ileostomy closure, a patient requires diversion, we recommend creating a thoughtful ileostomy 20 cm proximal to the pouch. This can be a valuable step toward pouch salvage.