Our video describes the case of an 11yo boy with ulcerative colitis who required reconstruction after total abdominal colectomy with end ileostomy. In the video we demonstrate our technique to dissect very low in the pelvis and then resect the distal most portion of the rectum below the peritoneal reflection. We accomplish this by everting the low rectal stump out of the anus and transecting the rectum extracorporeally using a contour stapler. We then invert the rectum again and complete our ileal pouch to anal anastomosis with an EEA stapler. Additionally, we demonstrate that the entire reconstruction can be done with the same 3 trocar sites as his previous laparoscopic total abdominal colectomy and end ileostomy which minimizes scarring. We believe this technique and setup optimizes a multi-staged operation in a highly complex patient population.