Two cases of familial polyposis coli were managed by total colectomy and endorectal pull-through with excellent long-term results. The performance of a temporary loop ileostomy is advisable to prevent anastomotic complications. In addition, it avoids the excessive diarrhea and perianal excoriation that frequently occur in the early postoperative period until full continence is regained. This is the only method that allows the preservation of rectal function and prevents the occurrence of rectal cancer. It should be considered as a real alternative to either subtotal colectomy and ileorectal anastomosis or total colectomy with construction of an ileostomy.