**4. When the rectum cannot be spare**

When the rectum cannot be spare, it is mandatory to rule out the presence of relative or absolute contraindication for IPAA. There are absolute contraindications for IPAA: They are the presence of poor anal sphincter function with fecal incontinence in all pathologies, the distance between the tumor and pectin line inferior to 1 cm or sphincter involvement in distal rectal cancer, and the presence of perianal disease beyond proctocolitis in Crohn disease. The aggressive phenotype in FAP, indeterminate proctocolitis, and Crohn's disease, with involvement limited to the colon and rectum, are the relative contraindications. Morbid obesity increased technical difficulties and can be considered a relative contraindication, as the willingness in young women to get pregnant.
