Most patients with universal ulcerative colitis ultimately require a colectomy either to treat the inflammatory process or to prevent the subsequent development of a malignant tumour. Since the introduction of total proctocolectomy and ileostomy for the definitive surgical management of ulcerative colitis, this procedure has become the standard operative therapy for this disease. The description of the eversion technique of ileostomy in 1952 improved the life-style of patients with an ileostomy and made the total proctocolectomy a more attractive procedure. Nevertheless, many patients are emotionally disturbed by having an incontinent ileostomy and often will delay their surgery because of the associated psychologic trauma. Because of this, the Kock pouch or continent ileostomy has been introduced and advocated during the past decade. This procedure has met with notable success but has found less application in the younger patient. However, even the continent ileostomy is associated with a certain amount of psychologic trauma because of the abdominal stoma. Therefore, the endorectal pull-through has recently been used for the management of ulcerative colitis. First introduced in 1948, this procedure allows total removal of the diseased bowel, maintains continence and eliminates the need for an ileostomy. During the last 3 1/2 years, the author has used the endorectal pull-through to treat 24 patients with ulcerative colitis and 1 with familial polyposis. The results are encouraging in that all patients are continent and the average daily stool frequency is 6 to 10. These results and those of others support the continued use of this new surgical approach to the management of ulcerative colitis.