The procedure is tailored to the condition, disease extent, and patient health:

1. Before Surgery Evaluation:
   
   • Diagnosis:
     
     • Colonoscopy with biopsy confirms UC, Crohn’s, or cancer.
     • CT scan assesses disease extent, complications (e.g., perforation), or metastasis.
     • Blood tests evaluate inflammation (CRP, ESR), anemia, and surgical fitness.
   • Bowel preparation (laxatives, enemas) clears the colon 1–2 days prior, unless contraindicated (e.g., obstruction).
   • Antibiotics (e.g., metronidazole, ciprofloxacin) are given for infection or prophylaxis.
   • An enterostomal therapist marks a stoma site, as an ileostomy may be needed.
2. Surgical Techniques:
   
   • Total Colectomy with Ileorectal Anastomosis:
     
     • Performed under general anesthesia, lasting 3–5 hours.
     • The entire colon (cecum to sigmoid) is removed, sparing the rectum.
     • The ileum is anastomosed to the rectum (ileorectal anastomosis).
     • A temporary loop ileostomy may be created to protect the anastomosis, especially in emergencies or high-risk patients (e.g., UC patients with active inflammation).
   • Total Colectomy with End Ileostomy:
     
     • For cases where rectal preservation isn’t feasible (e.g., severe rectal involvement, emergency).
     • The colon and rectum are removed (proctocolectomy), and a permanent end ileostomy is created to divert stool into a pouch.
     • Takes 4–6 hours, often combined with perineal incision if the rectum is removed.
   • Laparoscopic Total Colectomy:
     
     • Minimally invasive, using 4–5 small incisions, a laparoscope, and instruments.
     • Suitable for elective cases (e.g., UC, FAP), offering less pain and faster recovery.
     • Takes 3–5 hours; conversion to open surgery is possible if complications arise.
   • Robotic-Assisted Total Colectomy:
     
     • Uses robotic systems (e.g., da Vinci) for enhanced precision, particularly in the pelvis.
     • More expensive, available in centers like Apollo or Medanta.
3. After Surgery:
   
   • ICU monitoring for 1–2 days manages pain, fluids, and bowel/stoma function.
   • Hospital stay: 7–14 days (open), 5–10 days (laparoscopic/robotic).
   • Pathology reports guide further management (e.g., chemotherapy for cancer, Crohn’s monitoring).
   • Stoma care training is provided for ileostomy patients.