Textbook outcomes are feasible and crucial for improving long-term results in ileal pouch-anal anastomosis for ulcerative colitis.

• 57% of patients achieved textbook outcomes, reducing pouchitis risk by 67%.
• Male sex, higher preoperative albumin levels, and UC-associated neoplasia were linked to better outcomes.

Embracing these quality metrics can enhance surgical practices and patient selection.

• Achievement of textbook outcomes has improved annually alongside minimally invasive surgery adoption.