When surgery is required the recommended procedure is a subtotal colectomy with end ileostomy. The traditional bowel resection is made using an open surgical approach, called colectomy. Severe CMV colitis may lead a colectomy. Malignant transformation of polyps requires surgical colectomy. In those with severe "C. difficile" colitis, colectomy may improve the outcomes. A Kock pouch is a continent pouch formed by the terminal ileum after colectomy. The study included 109 patients undergoing open, elective, total abdominal colectomy. Without colectomy, colon cancer is virtually inevitable. A colectomy may also be utilized in the treatment of colon cancer. Wherever apparently possible, Lane replaced colon bypass and colectomy with pericolic membranotomy. Lane began with colon bypass, and then, at insufficient improvements, performed total colectomy. He had major intestinal ruptures as a result, and underwent a colectomy. Meanwhile, colectomy for constipation was abandoned amid low success rates but high complication rates. A Kock pouch need not be created during the initial colectomy surgery. By 1982, colectomy for constipation was declared "clinically futile".