Restorative proctocolectomy with ileal pouch–anal anastomosis is a widely recognized surgical procedure commonly employed in the management of ulcer-ative colitis patients. The surgical intervention results in the formation of a novel anatomical structure, which subsequently gives rise to a range of structural, inflammatory, and physiological effects in the short, medium, and long term. According to the guidelines released by the International Ileal Pouch Consortium in 2021, chronic antibiotic-refractory pouchitis was delineated as a condition characterized by a lack of clinical and endoscopic response or minimal response following conventional antibiotic therapy lasting 2-4 weeks, regardless of any prior positive response to antibiotic treatment. If the aforementioned alterations are not subjected to thorough evaluation and effectively managed, they have the potential to lead to the loss of a pouch and the subsequent establishment of a permanent ileostomy.