The percentage of patients with chronic ulcerative colitis in whom surgery is indicated will vary with the severity of the disease and the length of time which these patients have been followed. In our experience 40% of patients with chronic ulcerative colitis will require surgical intervention either because of a complication of the disease or because they have failed to respond to medical treatment. Internists, gastroenterologists, and surgeons alike have learned to recognize those patients with severe chronic ulcerative colitis who will not survive unless their disease process is removed surgically. They have also learned to recognize those patients who will survive only as chronic invalids, unable to continue in school or to earn a living because of malnutrition, chronic anemia, or general debility so often associated with this long-standing disease.
Experience has also demonstrated that in the great majority of patients who require surgical intervention a permanent ileostomy and