en MIS MIS Letter/Editorial Letter/Editorial The role of protective ileostomy for restorative proctocolectomy<br> has been debated. Although anastomotic complications<br> can be minimized with protective stoma (1),<br> several authors have reported good outcomes in patients<br> who have undergone restorative proctocolectomy without<br> ileostomy (2-5). A previous report has suggested the<br> possibility of rectal cancer development from the rectal<br> mucosa remnants resulting from ileal pouch&ndash;anal anastomosis<br> (IPAA) performed using the stapling technique (6).<br> Therefore, some authors have suggested the selective use<br> of this technique, particularly in patients with familial adenomatous<br> polyposis with rectal sparing; while in other<br> cases, rectal mucosectomy and hand-sewn IPAA have been<br> recommended (7), because the functional or manometric<br> outcome of staple and hand-sewn IPAA is not significantly<br> different (7, 8). However, lifelong surveillance of the IPAA is<br> essential in all patients.<br> The key factor to a successful operation is tension-free<br> anastomosis with good blood supply to the ileal pouch.<br> Therefore, ileal pouch elongation is a crucial step, particularly<br> in patients with hand-sewn IPAA, where an additional<br> ileal length of 3&ndash;4 cm may be required. Several techniques<br> for ileal pouch elongation have been reported, e.g., selective<br> division of branches of the superior mesenteric artery or division<br> of the ileocolic artery. Some authors have advocated<br> preserving the middle colic artery as an additional blood<br> supply route (9). We have proposed the technique of dividing<br> the submesenteric arcades and preserving 3 or 4 of the<br> innermost arcades of the distal ileum as well as both the Laparoscopy Proctocolectomy, Restorative Ileostomy 0 0 http://annbsurg.iums.ac.ir/browse.php?a_code=A-10-31-235&slc_lang=en&sid=1 Chucheep Sahakitrungruang 1003194753284600603 1003194753284600603 Yes 1 Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand