The procedure varies based on the condition and whether sphincter preservation is feasible:

1. Before Surgery Evaluation:
   
   • Diagnosis:
     
     • Colonoscopy with biopsy confirms UC, Crohn’s, or cancer.
     • CT/MRI assesses disease extent, complications (e.g., fistulas), or metastasis.
     • Blood tests evaluate inflammation (CRP, ESR), anemia, and surgical fitness.
   • Bowel preparation (laxatives, enemas) clears the colon 1–2 days prior.
   • Antibiotics (e.g., metronidazole) may be given for infection or prophylaxis.
   • An enterostomal therapist marks a stoma site for an ileostomy.
2. Surgical Techniques:
   
   • Total Proctocolectomy with End Ileostomy:
     
     • For UC, Crohn’s, or FAP when sphincter preservation isn’t possible.
     • Performed under general anesthesia, lasting 4–6 hours.
     • The entire colon, rectum, and anus are removed via abdominal and perineal incisions.
     • A permanent end ileostomy is created on the abdominal wall to divert stool into a pouch.
   • Proctocolectomy with Ileal Pouch-Anal Anastomosis (IPAA):
     
     • For UC or FAP, preserving continence.
     • The colon and rectum are removed, but the anal sphincter is preserved.
     • A J-shaped pouch is constructed from the ileum and anastomosed to the anus.
     • A temporary loop ileostomy is often created to protect the pouch, reversed after 3–6 months.
     • Takes 5–7 hours, often staged (2–3 surgeries) for unstable patients.
   • Laparoscopic Proctocolectomy:
     
     • Minimally invasive, using 4–5 small incisions and a laparoscope.
     • Suitable for stable patients, offering less pain and faster recovery.
   • Robotic-Assisted Proctocolectomy:
     
     • Uses robotic systems (e.g., da Vinci) for precision, minimizing nerve damage.
     • Available in advanced centers like Apollo or Medanta.
3. After Surgery:
   
   • ICU monitoring for 1–2 days manages pain, fluids, and stoma function.
   • Hospital stay: 7–14 days (open surgery), 5–10 days (laparoscopic/robotic).
   • Pathology reports guide further management (e.g., cancer staging, Crohn’s recurrence risk).
   • Stoma care training is provided for ileostomy patients.