Our experiences with 26 patients show that total proctocolectomy with direct ileoanal pouch anastomosis and without maintenance of the rectal muscle cuff proves to be an excellent method for secure and lasting treatment of UC and ACR as well as of manifest cancer. The advantage of this method is the maintenance of normal continence function at a lower operative risk and few postoperative complications. Contraindication for this operative approach is still Crohn' disease. Furthermore the indication is limited by primary dysfunction of the anal sphincter.