If the colon and rectum need to be removed in patients with ulcerative colitis, it is preferable to create an ileo-anal pouch to restore continuity of the intestinal tract. The surgical approach and the centre at which the patient can best have his surgery are still under debate. Laparoscopy seems to be the best approach due to faster recovery, better fertility preservation, less adhesion formation and fewer incisional hernias. The procedure should be performed in a tertiary referral centre with an annual volume of more than 20 cases.