In order to determine the results with the S ileal pouch-anal anastomosis, 116 consecutive patients who had undergone total abdominal colectomy with rectal mucosectomy and endorectal ileal pouch-anal anastomosis were assessed following ileostomy closure. In 11 patients (9.5%) pouch removal and/or conversion to permanent ileostomy was necessary because of Crohn's disease (3), pelvic sepsis (3), pouchitis (2), incontinence (2), or perineal fistula (1). Although no postoperative mortality was experienced, one or more complications was experienced in 87 patients. These consisted mainly of small bowel obstruction in 35%, pouchitis in 22%, anastomotic stricture in 14%, pelvic sepsis in 9.5%, and perianal abscess or fistula in 5%. Laparotomy was required in 29% of patients mostly for resolution of small bowel obstruction. Follow-up in the remaining 105 patients ranged from 5 to 67 months with a mean of 28 months following ileostomy closure. Stool frequency was 6.6 bowel movements per day and 1.4 bowel movements per night. Eighty-nine percent evacuated their pouches spontaneously, and 61% did not require the use of medication for bowel movement regulation. Major daytime incontinence occurred in 4%, while 15% reported nocturnal incontinence. Minor incontinence was experienced by 30% and 48% during daytime and nighttime, respectively. Despite a myriad of complications, 96% of patients unhesitatingly stated that they would undergo the procedure again so that they could avoid a permanent stoma. We conclude that restorative proctocolectomy utilizing the ileal S pouch-anal anastomosis is an acceptable procedure that should be considered as a viable choice in the treatment of chronic ulcerative colitis and familial polyposis requiring surgical intervention.