Since 1978, when Sir Alan Parks reported an S-shaped ileonal pouch at St. Mark's Hospital in London, the ileoanal pouch procedure has undergone many revisions and refinements. Functional outcomes and quality of life have vastly improved since the earlier days of the straight ileoanal anastomoses. The ileal pouch anal anastomosis has now become the surgical procedure of choice for patients with ulcerative colitis and familial adenomatous polyposis, avoiding permanent stomas and establishing gastrointestinal continuity and anal continence. In this video, we present our technique of restorative proctocolectomy ileal J-pouch anal anastomosis for a patient with ulcerative colitis.