This dissertation examines the innovations in the surgical treatment of the chronic intestinal disease ulcerative colitis (UC). There is a range of medical therapies that a patient with UC can use to reduce symptoms and/or colonic disease. In case medication lacks efficacy, surgical treatment may be an option or, in some cases, necessary. The first part of my dissertation focuses on the role of the appendix in UC. Over the past decades, research has shown that removing the appendix protects against developing UC. For this reason, appendectomy as a therapy for UC has been examined. Promising results have been described thus far. This dissertation supports the findings of previous research; appendectomy can reduce the severity of UC and/or delay a potential later colectomy. Approximately half of the patients who underwent an appendectomy showed long-term improvement in disease activity of the intestinal wall. This dissertation also contributes to the identification of patients with an inflamed appendix through endoscopy and/or ultrasound examination. Patients with an inflamed appendix seem to benefit more from an appendectomy. If neither medication nor appendectomy mitigates UC, the ultimate surgical intervention for refractory UC is removal of the entire colon, including the rectum (proctocolectomy). A new rectum can be created out of small intestine tissue, known as a pouch. This complex operation is called a proctocolectomy with ileal pouch-anal anastomosis (IPAA). IPAA surgery is known to be a complicated procedure. This dissertation maps out common causes of pouch failure and the best intra- and postoperative approach to reduce and treat complex long-term complications, particularly pouch failure. In conclusion, this dissertation paves the way for the surgical approach to UC.