Restorative proctocolectomy (RPC) has evolved as a procedure for the treatment of mucosal pathologies such as ulcerative colitis (UC) and familial adenomatous polyposis (FAP) while preserving intestinal continuity and anal continence [1]. The two key concepts on which it is based are ileoanal anastomosis [2] and construction of an ileal reservoir proposed, even if in different clinical situations, by Valiente and Bacon [3] and Kock [4] and subsequently integrated in the ileoanal anastomosis by Parks and Nicholls [5].

Since the period of the original description, the operation underwent many technical improvements which simplified the procedure, contained the mor-bility and improved the functional results [6, 7]. RPC with an ileal pouch-anal anastomosis (IPAA) is a complex and sophisticated operation; even if perioperative mortality is low (0-1%), specific surgical complications are about 25-40%, with the need to perform surgical revisions in 15-25% of cases [8]. Nevertheless, the functional results that may be obtained in terms of continence and acceptable intestinal function determine a high degree of satisfaction in relation to patient lifestyle [9]. Some controversies about some surgical aspects and patient selection criteria still exist even if issues about pouch duration and stability in the long run and its morphological and functional changes are actually considered much more important.

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