: Since 1981 12 patients (11 adenomatosis coli = AC/1 ulcerative colitis = CU) had a colectomy and mucosal proctectomy with ileo-anal anastomosis (IA) and formation of an ileal-S-pouch (IP). The mean age of 7 men and 5 women was 33 years (21-46 yrs). We preferred the synchronous abdomino-peranal operation. Protective ileostomy was closed after a mean of 4.6 months in 11 patients. Postoperative complications: IA-insufficiency = 4, sacral abscess = 1, stenosis = 3, ileus and reoperation = 2). Late results: spontaneous defecation: 11/11, continence 10/11, evacuation 6-8/day. This operative procedure seems to be good for AC and CU.