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Background: Restorative proctocolectomy with ileal-pouch anal (canal) anastomosis (IA(C)A) is the standard procedure for ulcerative colitis (UC). However, some patients require permanent ileostomy because of some complications after IAA. Aim: The aim of this study was to clarify the incidence and clinical feature of the patients who necessitated permanent ileostomy after IAA for UC. Methods: Medical records of the patients who underwent permanent ileostomy after IAA for UC were reviewed retrospectively. There were 251 patients who underwent IAA in our department since 1987, and 11 patients (4.4%) necessitated permanent ileosotomy therafater. We compared backgrounds between patients who required permanent ileostomy (N=11; ileostomy group) and those who did not (N=240; control group). Patients in ileostomy group were divided into 3 subgroups based on indications for constructing ileostomy; intractable anal or ano-vaginal fistula (Group A, N=4), stricture of IAA (Group B, N=4), and severe fecal incontinence (Group C, N=3). We compared clinical features among these 3 subgroups. Results: There were no differences between ileostomy and control groups in the age undergoing IAA, the mean period from diagnosis as UC to surgical treatment, indication for surgical treatment, severity and spread of UC. (Thus, no specific background was found for patients requiring permanent ileostomy after IAA.) The mean age (range) undergoing IAA in group A, B, and C was 25 (17-36), 37 (21-48), and 48 (29-66), respectively. The mean time interval (range) bewteen the closure of temporary covering ileostomy and contruction of permanent ileostomy in group A, B, and C was 9.5 (3-23 years), 5.8 (2 months-9 years), and 2.3 (1 month-5 years) years, respectively. Thus patients who required permanent ileostomy because of fistula tended to undergo IAA at relatively young age and had long time interval, while those who necessitated permanent ileostomy because of fecal incontinence tended to undergo IAA at relatively old age and had short time interval. Conclusions: These results indicate that, in patients necessitating permanent ileostomy after IAA for UC, the surgical indication for permanent ileostomy was associated with age undergoing IAA and time interval between the closure of temporary ileostomy and the contruction of permanent ileostomy. The Long term follow-up is important, because some patients required permanent ileostomy over 20 years after restorative proctocolectomy for UC.