Construction of an Heal pouch reservoir produces stasis within the distal small bowel. This is desirable in patients with an ileal pouch-anal anastomosis or a Kock continent ileostomy, as post operative stool frequency is directly related to the maximum capacity of the ileal reservoir [15, 16]. The corollary is that the ileal reservoir must evacuate efficiently to maximise benefits of a large reservoir and to minimise biological effects of stasis within the distal ileum . The importance of efficient pouch evacuation to clinical outcome has been clearly demonstrated in patients with ileal ‘S’ pouch anal anastomosis . Impairment of ileal pouch evacuation resulted in ileal pouch intubation at least once per day in 50% of patients. Animal studies confirmed that the ‘S’ pouch reservoir with a long efferent limb empties poorly, perhaps by overflow . Contrast radiology confirmed that a long ileal pouch efferent limb was obstructive . These observations led to changes in ileal pouch design with shortening of the obstructive efferent limb in ‘S’ pouches and to development of other non-obstructive ileal pouch designs.