A recent study published in the Journal of Pediatric Surgery aimed to quantify the incidence of loss of an ileoanal pouch in children and to identify variables associated with this event. Here, 103 children underwent ileoanal pouch at the median age of 14 years. Indications and mean age were: ulcerative colitis (n=71, 14 years); polyposis syndromes (n=13, 15 years); chronic idiopathic constipation (n=9, 11years); Hirschsprungs disease (n=4, 1 year); Crohns disease (n=2, 16 years); and fibrosing colonopathy (n=2, 11 years). Among these 13 patients had their pouch excised or permanently diverted, whereas three patients had successful revision pouch surgery. It was observed that only pre-operative fecal incontinence and anastomotic leak were significantly associated with pouch excision/diversion. However on multivariate analysis, only fecal incontinence remained significant. Meanwhile, pouch survival was significantly worse where there was fecal pre-operative incontinence or an anastomotic leak. The findings were summarized as: 13% of children subjected to restorative procto-colectomy ultimately receive a permanent ileostomy; fecal incontinence prior to surgery is a relative contra-indication; anastomotic leak increases the probability of later pouch excision.