A prolonged period of preoperative hyperalimentation or nonalimentation with catabolism may be avoided by a staged procedure, especially in the presence of toxic megacolon, poor general condition, or rectal disease. A permanent ileostomy is performed with subtotal colectomy, leaving the rectum in place, and the superior hemorrhoidal vessels undivided. This also offers the chance to review the pathology of the colon to further exclude Crohn's disease. After several months, an ileoanal anastomosis is considered and a diverting ileostomy is created at the time of the pouch. After a suitable recovery the temporary ileostomy is closed making this a three-stage procedure. Various pouches have been advocated. They include the J pouch (Figure 2, A), the three loop S pouch (Figure 2, B), the lateral isoperistaltic ileal reservoir (Figure 2, C), and the four-loop W reservoir (Figure 2, D).