The endorectal pull-through, a sphincter-saving operation, has become the procedure of choice for the definitive management of ulcerative colitis and familial polyposis in both children and adults for the past fifteen years. Controversies exists as to whether this procedure should be combined with a reservoir when the entire colon has been resected. At our institution, we have perform a total colectomy, a mucosal proctectomy and a straight ileo-anal and pull-through for the above two diseases without a pouch or reservoir because the functional results are similar to those with a puoch and the complications are far less. This same operation has also been carried out in our institution for the management of total colonic Hirschsprung's Disease. This manuscript focuses on the operative technique for performance of the total colectomy and ileo-anal endorectal pull-through and the results of this operation in 116 patients with ulcerative colitis and 30 patients with familial polyposis. In addition, our experience with 18 children with total colonic Hirschsprung's Disease is also reviewed. The final portion of the paper compares our results with the straight endorectal pull-through with those of the endorectal pull-through combined with a reservoir and demonstrates that the clinical and functional outcomes are not different.