**1. Introduction**

Restorative proctocolectomy with ileal pouch-anal anastomosis (RPC-IPAA) is a complicated colorectal surgical procedure. It is mainly used to treat patients with familial adenomatous polyposis (FAP) and ulcerative colitis (UC). It is also performed to treat selected patients with Crohn's disease (CD), indeterminate colitis, and synchronous colorectal cancer (CRC) [1]. Among these pathologies, ulcerative colitis is the primary postoperative histopathological diagnosis, as Fazio data show, in 2013 [2].

IPAA surgery, first described by Parks and Nicholls in 1978 [3], aims to definitively cure disease and prevent malignant degeneration while providing adequate continence and avoiding a permanent stoma.

The majority of patients experience long-term success but are not absent from significant surgical complications. The main ones are pelvic sepsis, pouchitis, pouch failure, fecal incontinence, female infertility, and sexual dysfunction. Others, like stenosis, pouch dysplasia/cancer, IPAA prolapse, preileal IPAA pouchitis, and anemia, are rare [4].

IPAA results depend on several factors, such as the pathology underlying and specific features, gender, age, IBM, patient comorbidities, surgical techniques, and surgeon experience.

So, before to propose or avoid RPC with IPAA, there are aspects to take into account:

