Introduction: Ulcerative colitis (UC) is a chronic relapsing inflammatory bowel disease limited to the colonic mucosa, with rising incidence and prevalence in many regions of the world, including Latin America. A subset of patients requires colectomy for medically refractory disease, acute severe colitis, dysplasia, or malignancy, for whom restorative proctocolectomy with ileal pouch-anal anastomosis (RPC-IPAA) is the preferred restorative procedure. Pouch-related complications -- including pouchitis, chronic antibiotic-refractory pouchitis (CARP), pouch failure, and diagnostic reclassification to Crohn's disease -- represent major clinical challenges; however, published institutional data on RPC-IPAA outcomes from hospital centers in Mexico and Latin America remain exceptionally scarce. This descriptive single-center study aimed to describe the demographic profile, operative characteristics, and predefined pouch-related complications in patients with UC who underwent RPC-IPAA at a tertiary referral center in Mexico. Methods: A retrospective observational study was conducted at the Inflammatory Bowel Disease Clinic of the Coloproctology Service, Hospital General de México "Dr. Eduardo Liceaga," reviewing medical records of UC patients who underwent RPC-IPAA between 2010 and 2022. Demographic and clinical variables were analyzed using IBM SPSS Statistics, version 29 (IBM Corp., Armonk, NY). Quantitative variables were summarized as mean ± SD and categorical variables as frequencies and percentages. Pouchitis was diagnosed using the Pouchitis Disease Activity Index (PDAI ≥7). CARP was defined as active pouchitis (PDAI ≥7) persisting despite at least four consecutive weeks of antibiotic therapy and failure of at least two sequential antibiotic regimens. Postoperative follow-up was calculated from the date of pouch creation to the last clinical encounter. Results: Fourteen patients were included; 8 (57.1%) were women. Mean age was 34.86 ± 7.94 years. All patients had Montreal E3 pancolitis. The mean interval between UC diagnosis and pouch creation was 3.86 ± 1.81 years. The median postoperative follow-up was 6.2 years (IQR: 3.4-9.1 years; range: 0.5-12.0 years). J-pouch construction was performed in 13 (92.9%) patients and D-pouch in 1 (7.1%). One (7.1%) patient experienced pouch failure and underwent W-pouch reconstruction. One (7.1%) patient originally diagnosed with UC E3 was subsequently reclassified as Crohn's disease (Montreal A2L4B2) and is currently receiving anti-interleukin-12/23 therapy (ustekinumab). Pouchitis occurred in 4 (28.6%) patients; all developed CARP and are currently being treated with anti-integrin therapy (vedolizumab). Conclusions: In this descriptive single-center study, RPC-IPAA was predominantly performed with J-pouch construction, achieving durable pouch preservation over a median follow-up of 6.2 years. Pouch-related complications -- including CARP, pouch failure, and diagnostic reclassification to Crohn's disease -- emerged as important sources of morbidity requiring escalation to advanced biologic therapy and, in selected cases, surgical reintervention. These findings underscore that successful pouch surgery depends on structured individualized surveillance, dedicated multidisciplinary care, and timely access to biologic therapies throughout the postoperative course.
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