An experience is reported with 23 patients who underwent rectal mucosectomy, total colectomy, creation of S-type pouch, and ileoanal anastomosis for ulcerative colitis (21 patients) or familial polyposis (two patients). There were no deaths. There were 23 complications requiring 18 operations in 16 patients. Twenty-one patients have been followed an average of 17.8 months (range 2 to 34 months) Frequency of bowel movement averaged 9.8 per day initially and 6.2 per day at the time of follow-up. None of the patients consider themselves incontinent, although 15 have had some degree of perianal soiling and at least on occasion have worn a pad. One patient intubates the pouch regularly, six intubate it on occasion, and 14 do not intubate at all. The size of the outflow treat of the pouch has been shortened from 5 to 2 cm in the last seven patients; six of these patients do not intubate and four report no soiling at all. Eleven patients have made changes in their diet or eating habits to promote more predictable bowel function and 13 take a variety of antidiarrheal medications. Nineteen patients are satisfied with the procedure and prefer the pouch to a conventional ileostomy; the other two have since undergone conversion to a Brooke ileostomy. Despite frequent bowel movements, complications, and some problems with perianal soiling, patient acceptance remains high with the endorectal pull-through and S pouch in adults, and further study, particularly using a shortened outflow tract, appears warranted.