This is a retrospective study whose findings have significantly influenced the current practice of restorative surgery for ulcerative colitis. Stapled ileal pouch-anal anastomosis is associated with decreased perioperative morbidity and improved functional results. The putative advantages associated with mucosectomy, and then hand-sewn anastomosis include complete disease removal with elimination of cancer risk in the anal transitional zone. This has not turned out to be the case and stapled technique has become the preferred standard of care for ileal pouch-anal anastomosis.