BACKGROUND: The number of patients with ulcerative colitis (UC) is increasing rapidly in Asia. No large study has evaluated the clinical outcomes of hand-sewn ileal pouch-anal anastomosis (IPAA). This study aimed to create a large database of the surgical outcomes of UC, present the trends of surgical procedures, and evaluate the impact of minimally invasive procedures on UC. METHODS: Data of patients first treated from 2005 to 2019 were collected; two-staged surgery data were extracted, and minimally invasive surgery (MIS) and open surgery (OS) outcomes were compared using propensity-score matching. RESULTS: The data of 1558 cases were selected as the main analysis set. The number of surgical cases of UC has been increasing, with increasing proportion of MIS cases (2005: 43%, 2019: 84%). The median age of the patients increased in these 15 years (39.5-56 years old). Of 873 patients who underwent two-staged surgery, after 3:1 matching, 408 MIS and 176 OS cases were compared. Hand-sewn anastomoses were performed in 293 MIS (72.0%) and 142 OS-IPAA (80.7%) cases. The proportion of early complications (>/= Grade 3) did not vary between the two groups. Intraoperative blood loss was lower and blood transfusions were less frequent in the MIS group. CONCLUSIONS: The proportion of MIS for UC has rapidly increased over the past 15 years. The total number of MIS and OS complications did not vary significantly between the groups. The short-term advantages of MIS include reduced blood loss and less necessity for blood transfusions.