Two instruments, the time trade-off technique and direct questioning of objectives, were used to assign the worth (utility) of the perceived quality of life of patients who had ulcerative colitis requiring surgery. Utilities ranged from 0 to 1 with 0 signifying death and 1 signifying full health. Two groups of patients were studied. Group 1 consisted of 20 patients (14 male and 6 female; mean age, 34.0 +/- 10.3 years) who were studied preoperatively and 1 year postoperatively. The mean preoperative utility was 0.58 +/- 0.34 using the time trade-off technique and 0.38 +/- 0.27 using the direct questioning of objectives. Mean utilities were significantly higher postoperatively, 0.98 +/- 0.07 using the time trade-off technique and 0.88 +/- 0.19 using the direct questioning of objectives (P less than 0.05). Group 2 included 93 patients who had had surgery at least 1 year previously. Twenty-eight had conventional ileostomies, 28 had Kock pouches, and 37 had ileal reservoirs. Mean utilities for these three subgroups ranged from 0.87 +/- 0.18 to 0.97 +/- 0.6. No significant differences were detected among the three subgroups. This study suggests that quality of life is improved after surgery for ulcerative colitis and is high irrespective of the surgical procedure.