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In this week's episode of the Ileal Pouch Series, Dr. Antonio de Lacy PhD elucidates the advantages of the transanal approach in patients with carcinoma after proctocolectomy. Dr. Lacy presents a video-clinical case of a 31yr old female with PAF, treated initially with a total proctocolectomy with J-pouch reconstruction, with suspected neoplasia of the remaining rectal mucosa. The transanal approach was chosen to perform the new resection and redo the anastomosis, with favorable results.