The availability of novel techniques to treat end-stage FI gives hope for a better quality of life in patients who were traditionally treated by a permanent stoma. The diversity of causes of FI and the different modes of action of the various treatment modalities mandate a tailored, individualized approach in each case. A meticulous preoperative evaluation process is imperative in the course of the decision-making of which procedure to perform, with full awareness that a stoma still may be the best option for some patients who have end-stage FI.