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Brandon M Shore,1 Bharati Kochar,2,3 Hans H Herfarth,4,5 Edward L Barnes4,5 1Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 2Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA; 3The Mongan Institute, Boston, MA, USA; 4Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; 5Center for Gastrointestinal Biology and Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USACorrespondence: Edward L Barnes, Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Campus Box #7080, 130 Mason Farm Road, Chapel Hill, NC, 27599-7080, USA, Tel +1 919-962-3112, Fax +1 919-966-6842, Email edward_barnes@med.unc.eduAbstract: The population of older patients with inflammatory bowel disease (IBD) is expected to continue to increase in the coming decades, which necessitates and improved understanding of the critical issues faced by patients in this population. Although restorative proctocolectomy with IPAA remains the surgical procedure of choice for the majority of patients with medically refractory ulcerative colitis (UC) and UC-related dysplasia, the evidence surrounding surgery for older patients UC remains sparse. In particular, comparisons of outcomes among older and younger patients undergoing IPAA and comparisons between older patients undergoing IPAA and those undergoing proctocolectomy with end ileostomy remain an understudied and important issue, as evidence in this area will be used to guide patient-centered surgical choices among older patients who require colectomy for UC. In this narrative review, we review the available literature regarding IPAA for older patients, as well as the pre-, peri-, and postoperative factors that may influence outcomes in this population.Keywords: pouchitis, surgery, older age, ulcerative colitis, J-pouch