The optimization of surgical techniques has made it possible to now treat patients with deep-seated rectal cancer by performing deep anterior rectal resection with coloanal anastomosis while avoiding a permanent stoma. To prevent a high bowel movement frequency and limited continence with an imperative need to empty the bowel, the coloanal pouch operation was developed to construct a rectal substitute. Nowadays, patients with ulcerative colitis or familial adenomatous polyposis of the colon undergo proctocolectomy as the definitive treatment for their underlying disease. Continuity is restored by creating an ileoanal reservoir. This contribution describes the surgical indications and pathophysiological changes for the colon J-pouch and ileoanal reservoir. In addition, explanations of the surgical techniques for both procedures are presented. The functional results are compared with those of other reconstruction options and discussed, taking our own results into consideration.