**7. Main surgical complications in restorative proctocolectomy with ileal pouch anal anastomosis (RPC-IPAA)**

Surgical complications in RPC with IPAA are not unusual as functional deterioration of pouch and quality of life (QOL). Fazio et al. encountered in their data early perioperative complications in 33.5% of patients with a mortality rate of 0.1%. On the other hand, he refers to good functional outcomes and QOL in 95% [2]. Nevertheless, these results by Fazio, mainly the functional outcomes of the IPAA, are not reached in all centers, probably depending on the surgeon experience and the high patient volume. The most leading and frequent IPAA complications are described as follows:

#### **7.1 Pelvic sepsis**

Pelvic sepsis occurs in 9% of the procedure, and its presence increases the risk of pouch failure. Pelvic sepsis is a common early complication with far-reaching consequences of long-term pouch dysfunction, but prompt intervention (either radiological or surgical) reduces the risk of pouch failure. According to Lavryk et al., 4031 patients who underwent IPAA in 1983–2014 (patients with Crohn's disease or cancer were excluded), 357 (8.8%) developed IPAA-related pelvic sepsis with or without anastomotic dehiscence [33].
