Surgical indication for ulcerative colitis is fulminant colitis, intractability, cancer or dysplasia. New surgical indication should be established because new medical treatment such as leucocytoapheresis or intravenous cyclosporine treatment developed. Standard surgical procedure is ileal pouch anal anastomosis with rectal mucosal stripping and stapled ileal pouch anal anastomosis. Postoperative bowel function and QOL are satisfactory in both of them. Surgical treatment should be performed without any delay for the patients who do not respond medical treatment.