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Laparoscopic ileal pouch-anal anastomosis (IPAA) is safe, feasible with short-term benefits. Limited data exist on long-term benefits and no data are available on cross stapling of the IPAA. The aim of this study was to report long-term results with laparoscopic IPAA and to assess the safety of laparoscopic cross stapling.Data on demographics, operativeprocedure, morbidity and outcome were collectedprospectively on all patients who underwent laparoscopic IPAA under one surgeon from February 2006 to December 2009. All patients underwent assessment of the IPAA with pouchogram and exam under anaesthetic.Eighty patients underwent IPAA either with totalproctocolectomy (n = 56) or afterprevious emergency colectomy (n = 24). Early (< 30 days) postoperative morbidity occurred in 20% of patients. Readmission within 30 days of surgery occurred in 18 patients (22.5%) (mainly stomarelated) and 24 patients (30%) experienced morbidity during median follow-up of 26 months (range 5-50) with anastomotic stricture in 16 patients (20%). There has been a single case of small bowel obstruction and no incisional hernias. Four leaks were identified on contrast study all of which healed with time. The IPAA was at 2.75 cm (0-4 cm) above the dentate lineLaparoscopic IPAA is safe with good long-term outcome.