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Objective Ileal pouch-anal anastomosis (IPAA) is a technically demanding procedure for ulcerative colitis (UC), and preoperative tools to predict surgical difficulty remain limited. This study aimed primarily to evaluate the correlation between preoperative pelvimetric parameters and postoperative outcomes, while exploring their association with intraoperative surgical difficulty in IPAA.Design/method A retrospective, single-centre cohort study was conducted including 56 patients who underwent primary IPAA for UC between 2021 and 2024. Pelvimetric measurements were obtained from preoperative MRI or CT scans, normalised to body surface area (BSA) and correlated with postoperative outcomes and intraoperative surgical difficulty using univariate analysis.Results The median BSA-normalised measurements were pelvic inlet 66.7 mm, pelvic outlet 48.1 mm and pelvic depth 57.4 mm. A longer normalised S3–coccyx distance and greater pelvic depth were significantly associated with increased pelvic sepsis (p=0.003). The normalised S3–coccyx distance also correlated with a higher rate of pouchitis at 1 year (p=0.009). A wider interacetabular distance, reflecting pelvic width, was associated with greater intraoperative surgical complexity (p=0.007). No pelvimetric variable correlated with overall postoperative complications or functional outcomes.Conclusion Specific pelvimetric parameters, particularly pelvic depth and width, are associated with an increased risk of septic complications and greater intraoperative surgical complexity in IPAA. Incorporating preoperative pelvimetry into routine assessment may enhance risk stratification and inform surgical planning. Larger multicentre studies are warranted to validate these findings and refine patient selection for restorative proctocolectomy.