To evaluate the functional results of continence reconstruction techniques following total colectomy, an analysis of long-term follow-up, quality of life parameters, and recurrence of basal disease was conducted on 17 patients who underwent ileal pouch-anal anastomosis, and 16 who underwent ileorectostomy. Satisfactory results were achieved in 29 of the 33 patients, partial results were achieved in 3, and only 1 remained totally incontinent. While this outcome was independent of the reconstruction technique, a lower mean daily frequency of defecation, better day-night distribution, faster definitive recovery from surgery, a higher degree of rehabilitation, and a lower frequency of unplanned outpatient visits, hospitalizations, and minor complications were achieved after ileorectostomy than after pouch-anal anastomosis. Furthermore, better results were observed in patients who had undergone surgery for familial polyposis or complicated diffuse colonic diverticulosis, compared to those who had undergone surgery for inflammatory bowel diseases (IBD). During the postcolectomy stage, tumor recurrence was found in 5 of 7 patients with familial polyposis and histologically confirmed malignancy, compared to only 1 of 6 patients with negative histological results. Extracolonic manifestations developed in two patients with ulcerative colitis, and a small bowel obstruction occurred in one with Crohn's disease. These findings emphasize the importance of carefully selecting patients for each type of continence reconstruction method after total colectomy according to their individual requirements.