When surgical treatment is indicated in the course of ulcerative colitis, several operations may be performed. In the vast majority of patients, total proctocolectomy and ileal pouch-anal anastomosis is the procedure of choice. Other operations (total proctocolectomy with Brooke ileostomy, total colectomy with ileorectal anastomosis or with Kock pouch) can also be used in certain circumstances. Postoperative quality of life must be considered before any decision is finalized.