INTRODUCTION:The aim of this study is to report ten‐year results of ileal pouch‐anal anastomosis in selected patients with colorectal Crohn's disease for whom coloproctectomy and definitive end ileostomy was the only alternative.METHODS:41 patients (22 females/19 males) with a mean age of 36 ± 13 (range, 16‐72) years underwent ileal pouch‐anal anastomosis for colorectal Crohn's disease between 1985 to 1998. None had past or present history of anal manifestations or evidence of small‐bowel involvement. Diagnosis of Crohn's disease was established preoperatively in 26 patients, on the resected specimen after ileal pouch‐anal anastomosis, or after occurrence of Crohn's disease‐related complication in 15 patients.RESULTS:Follow‐up was 113 ± 37 months, (18‐174) 20 patients having been followed for more than 10 years. There was no postoperative death. Eleven (27 percent) patients experienced Crohn's disease‐related complications, 47 ± 34 months (8‐101) after ileal pouch‐anal anastomosis: 2 had persistent anal ulcerations with pouchitis and granulomas on pouch biopsy and were treated medically; 2 experienced extrasphincteric abscesses and 7 presented pouch‐perineal fistulas which were treated surgically. Among them, 3 patients with persistent perineal fistula despite surgery required definitive end‐ileostomy. Of the 20 patients followed for more than 10 years, 7 (35 percent) experienced Crohn's disease‐related complications which required pouch excision in 2 (10 percent).CONCLUSIONS:Ten years after ileal pouch‐anal anastomosis for colorectal Crohn's disease, rates of Crohn's disease‐related complications and pouch excision were 35 and 10 percent, respectively. These good long‐term results justify for us to propose ileal pouch‐anal anastomosis in selected patients with colorectal Crohn's disease (i.e., no past or present history of anal manifestations and no evidence of small‐bowel involvement) for whom the only alternative is definitive end ileostomy.