Significance

There is good evidence supporting the benefits of minimally invasive surgery in IBD patients. More recently, increasing interest has arisen for the performance of pouch surgery through the anus, resulting in several retrospective publications, confirming better outcomes. Despite the fact that early retrospective data have not demonstrated any difference, there is theoretical concern that transanal surgery may have an effect on the long-term pouch function. Moreover, transanal surgery performed for other indications (i.e. local excision of rectal polyps or early cancers) did not result in functional impairment. It is important to have better evidence about the functional impact of transanal surgery in pouch patients, since they will need their pouch for many decades. UC patients are usually receiving a pouch at a mean age of 35 years old and keep a normal life expectancy after surgery. It is important that surgery that results in early benefits (potential decreased length of stay, lower conversion rate to open surgery, etc) does not result in long-term harm.