The surgical standard for ulcerative colitis was complete proctocolectomy. Colectomy with mucosal proctectomy reduces the problems of the perineal wound essentially. A conventional ileostomy can be avoided by Kock's pouch technique. Correct operative technique reduces the complications with necessary reoperation to 10-20%. A non-specific pouchitis will develop in 25% of the cases but can mostly be treated with metronidazol. Another option is reconstructive proctocolectomy with ileal reservoir with ileo-anal anastomosis. Its complications rate is about the same, patients integrity and satisfaction remarkably high. Although both techniques are demanding and should be restricted to specialized centers, there is nowadays no indication to amputation of the rectum for ulcerative colitis. An ileorectal anastomosis is an acceptable option under effective supervision of the retained mucosa because of the risk of cancer development. Conservative surgery with resection and reresection remains the therapeutic approach to Crohn's disease until etiology and causal therapy are known although surgery is not curative for Crohn's disease. 10 years recurrence rate is 30-50% and cannot be predicted or definitely influenced. Therefore removal of the rectum and permanent ileostomy should be avoided as long as possible. Pouch procedures are not indicated. Moderate resections and good general care avoid short bowel syndrome and deficiency disease.