Surgery continues to play a major role in the management of ulcerative colitis because it may save the patient's life, eliminate the long-term risk of cancer, and most importantly, eradicate the disease. Surgical treatment of ulcerative colitis still remains a challenge for the surgeon despite growing knowledge about the disease and advanced surgical techniques. Optimal timing for surgery is the mainstay of a good outcome and is as important as the quality of surgery. Although as many as one third of patients with ulcerative colitis require at least one surgical procedure to address complications derived from their disease, the decision in favour of a surgical approach and its timing is rarely an easy one. It is estimated that approximately 30% of patients with ulcerative colitis will undergo colectomy during the course of the disease [ 1 ]. All indications for surgical treatment of ulcerative colitis can be divided into two major types: those requiring emergency surgery and those requiring elective operation.
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