In the last decade, restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) is considered as the procedure of choice in the surgical management of most patients with familial adenomatous polyposis and chronic ulcerative colitis. Beyond the attraction of this operation, which permit to completely remove disease-bearing mucosa, spare the anal sphincter, and avoid a permanent ileostomy, it remains a difficult procedure with not negligible complication rate. Correct operative technique is required: to the purpose, main technical aspects of IPAA are analysed.