**Abstract**

Restorative proctocolectomy with ileal pouch-anal anastomosis (RPC-IPAA) is a surgical procedure performed when excising the entire colon and rectum is need and reconstitution of the intestinal transit through an ileal pouch is made with anastomosis to the anus. It is mainly used to treat patients with familial adenomatous polyposis (FAP) and ulcerative colitis (UC). It is a complex surgery with potential complications, and the functional outcomes can be worse over time. So, it is essential to select the appropriate patient, proceed to a correct surgical technique, and know-how to deal with and solve the main ileal pouch complications. This chapter intends to be a reflection on this subject.

**Keywords:** restorative proctocolectomy, ileal pouch-anal anastomosis, ileal-anal pouch complications, ileal-anal pouch failure, ileal-anal pouch results, familial adenomatous polyposis, ulcerative colitis, Crohn's disease
