Except for emergency situations deriving from severe forms of UC (Ulcerative Colitis), surgical indications should be offered to patients resisting medical treatment, and to cases of cancer or pre-cancerous lesions.
The surgical technique should be adapted to the general condition of the patient and dis-cussed with a gastroenterologist specialised in inflammatory bowel diseases.
The different criteria to take into account are:

- high doses of corticosteroids for more than 10 days
- loss of more than 10% of the total weight since the onset of symptoms
- major hypoalbuminaemia (<25 g / L)

If one of these 3 criteria is met, it is recommended to remove the majority of the colon without immediate restoration of the digestive continuity. Once this has been done and the symptoms have improved, and the corticosteroid treatment has stopped, (on average 3 months), a second surgical procedure is suggested:

- either a restoration of digestive continuity with conservation of the rectum (in case of good control of the disease). The patient must be informed of the risk of potential resec-tion of the rectum in case of relapse (about 20% of cases)
- or a resection of the rectum with creation of a “neo-rectum” with intestine (in case of si-gnificant sequelae in the rectum due to UC, of active rectum disease, or cancer). The neo-rectum can later be affected by pouchitis, which alters the functional result in about 30% of cases.

The wish for pregnancy among women of childbearing age is a major factor to take into account when considering the (non-)preservation of the rectum, because the complete resec-tion of the rectum decreases fertility, even if this risk is very much reduced by laparoscopy.
After the operation, if the rectum has been preserved, preventive treatment is recommen-ded to avoid relapse.