OBJECTIVE To compare manovolumetric results and functional outcome after restorative proctocolectomy with either mucosal proctectomy and handsewn pouch-anal anastomosis or stapling. METHODS Prospective randomised study. METHODS University hospital, Sweden. METHODS 80 Consecutive patients undergoing restorative proctocolectomy. METHODS 37 patients were randomised to have mucosectomy and a handsewn anastomosis and 43 patients to have a stapled anastomosis. METHODS Comparisons of anal sphincter function and clinical outcome in terms of continence and overall functional score between the two groups of patients. RESULTS There was persistent reduction in anal resting tone at one year amounting to 29% in the handsewn group and and to 21% in the stapled group (p < 0.001 compared with preoperative in both groups). Daytime continence was similar, but patients with stapled anastomoses experienced less soiling during sleep, especially in the early postoperative period (5/43, 12% compared with 15/33, 45% at one month, p < 0.001). The arbitrary overall functional score was, however, similar in both groups. CONCLUSIONS Handsewn and stapled ileal pouch-anal anastomoses result in similar postoperative anal sphincter impairment and overall clinical outcome.