Ileoanal pouch anastomosis is frequently performed in patients who require total proctocolectomy. Performance of an ileoanal anastomosis allows for the avoidance of a permanent ileostomy and restores fecal continence. A straight ileoanal anastomosis has been successfully performed in some children with refractory ulcerative colitis (UC) with reasonable functional outcomes. However, in adults, the functional results of direct ileoanal anastomosis are not satisfactory with increased stool frequency and impaired continence. Therefore, current ileoanal anastomosis procedures usually involve creation of an ileal pouch as a “neorectum” with reservoir capacity. This procedure is called restorative proctocolectomy or ileal pouch–anal anastomosis (IPAA).