The continence preserving restorative proctocolectomy is the operation of choice for ulcerative colitis. Many technical aspects of the J-pouch procedure have been standardised. We prefer the hand-sewn pouch-anal anastomoses and construct a protective ileostomy in most patients. Latter allows to carefully assess the sphincter function postoperatively and--if necessary--to train the sphincter before restoring continence. The frequency of postoperative ileus is comparable to that after other major intraabdominal surgery. Septic pelvic complications occur in up to 10% of patients and determine the long-term prognosis of pouch function. Following pouch reconstruction, the stool frequency remains increased (4-6 per day) and continence may be partially impaired especially at night. These consequences are accepted by most patients. Because the ileoanal pouch procedure is a difficult and complicated operation, it should be performed by experienced surgeons only.