I read with great interest the series presented by Bananzadeh et al. (1). This series includes a group of 19 patients who underwent laparoscopic RESTORATIVE proctocolectomy (RPC) without ileostomy, performed by the same surgeon, to treat Familial Adenomatous Polyposis (FAP) between October 2008 and May 2011. Ileal pouch-anal anastomosis (IPAA) is currently the standard surgical alternative for the majority of ulcerative colitis (UC) and FAP patients. Despite the complexity of the operation, IPAA is safe (mortality: 0.5–1%) and carries an acceptable risk of non-life-threatening complications (10–25%), achieving good long-term functional outcomes with excellent patient satisfaction (over 95%). During the last decade, the surgical technique has evolved significantly, mainly due to the growing incorporation of laparoscopic approaches. Because it is a complex technical procedure, a temporary ileostomy proximal to the ileal pouch has typically been performed (2). Thus, the most controversial aspect of the study discussed here being the omission of ileostomy in a series of laparoscopic surgeries. A protective ileostomy may reduce anastomosis leakage, prevent pelvic sepsis and fistulization, thus preserving pouch function. Consequently, it should also prevent the need for re-laparotomy and most importantly, pouch failure.The rationale for this decision is based on the fact that a protective ileostomy may limit the severity of septic complications, as the prevalence of pouch-related septic complications varies between 6% and 37% (2). Furthermore, most patients are able to accept this temporary stoma well, although it may be a source of complications after its construction or closure.These complications may include dehydration and metabolic disorders, peristomal irritation, anastomotic fistula, intestinal obstruction, and others (3).