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In this first lecture, Dr. Roel Hompes speaks about the construction of the ideal ileal pouch. He defends that the transanal approach is the logical next step after the transabdominal subtotal colectomy, since it allows for a total proctectomy under direct vision and facilitates the pouch construction and anastomosis. He also presents the first data from a collaborative study between centers all over Europe that show positive results for the transanal approach.