Anastomotic leakage (AL) is a leading cause of pouch failure post-restorative proctocolectomy, and early intervention significantly improves outcomes.

• AL occurred in 13.6% of patients, with higher rates in low-volume centers (28.0% vs. 12.7%).
• The overall salvage rate for AL was 85.4%, increasing to 92% with early diagnosis and treatment.

Early assessment and targeted management can lead to better long-term stoma-free survival, particularly in patients undergoing a three-stage approach.

• Long-term stoma-free rates were 95.5% with early intervention compared to 41.7% for late diagnosis.