When a patient needs to undergo removal of their entire large intestine (the colon and rectum) a new pathway for the evacuation of digestive waste will be necessary. There are three surgical options for patients who need to undergo total colectomy. All options are available for patients with both UC and FAP.

1. Conventional Brooke Ileostomy
The procedure that has been performed for the longest period of time, since the mid-1950's, involves removing the colon and rectum including the anal opening and anal canal and creating a conventional Brooke ileostomy. The end of the small intestine is brought through an opening in the abdominal wall and sewn to the skin to create a projecting stoma about 3/4 inch long. This enables the intestinal waste to flow directly into the appliance which is glued onto the skin around the intestinal stoma itself. Since the small intestine is a continuous flow system the patient must permanently and always wear the appliance.

2. Ileoanal “J” Pouch
The operation that has been performed since the early 1980's involves removing the colon and upper rectum but leaving the anal canal. An internal pouch is created from the small intestine and this is connected to the anal canal. This operation goes by many names including J-pouch, ileoanal pouch, the pull-through procedure, and the IPAA (ileal pouch-anal anastomosis).

3. BCIR – Modified Kock Pouch-Continent Ileostomy
This operation was devised by Dr. Nils Kock in Sweden in 1969. It involves removing the colon and rectum and anal canal in the traditional way. At that point a pouch is created from the patient's own small intestine together with an intestinal valve. This is not a foreign device or object of any kind but is a doubled layer of small intestine. It is then brought as a stoma through the abdominal wall. Several times a day the patient will insert a tube (catheter) into the opening into the pouch and evacuate their intestinal waste into the toilet. There is no pain associated with this and there is no protruding stoma. The intestinal valve creates a self-sealing pouch so that no stool or gas will escape in between draining it. In addition, water from swimming or diving cannot enter the pouch.