Total abdominal colectomy is required for many colonic diseases. The authors studied the outcomes of this operation and the quality of life based on the decision to perform an ileostomy or an anastomosis. Patients who underwent total abdominal colectomy (excluding those with inflammatory bowel disease and chronic constipation) had either ileoproctostomy or ileostomy and were compared. Patients were surveyed to assess satisfaction. Thirty-seven patients with ileoproctostomy and 23 patients with ileostomy were identified. There were no significant differences between groups with regard to urgency of operation, preoperative and total blood units received, and preoperative hospital stay. Morbidity and mortality were higher in the ileostomy group (38 vs 57% and 5 vs 17%), with odds ratios of 2.14 and 3.68 respectively; this was not, however, statistically significant (P = 0.157 and 0.132, power = 20% and 6%). All (14 of 14) surveyed ileostomy patients were at least satisfied versus 90 per cent (19 of 21) of ileoproctostomy patients. Of the latter, only 15 of 20 patients were continent, with 6.85 average daily bowel movements. Total abdominal colectomy has high morbidity and mortality rates. Performing an ileoproctostomy does not influence outcome but may lead to a high frequency of bowel movements and incontinence in some patients.