As in any operation for IBD, colectomy and ileorectal anastomosis should be performed only after every effort has been made to control the disease medically. Only in uncontrolled disease should early proctectomy be advised on the grounds of lack of normal physical development and sexual immaturity. Ileorectal anastomosis should not be performed upon every patient requiring surgical treatment any more than proctocolectomy and ileostomy should be performed upon every patient. Unless there is severe persistent disease of the rectum or destruction of the anal sphincter, the rectum should be preserved because severe ulcerative proctitis may heal or improve postoperatively with further medical treatment. If further surgical treatment is necessary, conversion to an ileostomy can be undertaken, and there are now other alternatives, such as the continent ileostomy and the ileoanal anastomosis, with or without a pelvic pouch.