iPouch Consortium — International Pouch Surgery Quality Initiative
A grassroots initiative to improve patient outcomes in ileal pouch surgery by sharing evidence-based best practices.
Promoting an innovative approach to pouch surgery & caring for pouch patients.
iPouch FAQ
Frequently asked questions about the iPouch Consortium and ileal pouch (IPAA) surgery.
What is the iPouch Consortium?
iPouch.org is an international quality-improvement initiative that brings together leading IBD surgeons and gastroenterologists worldwide to advance the care of patients undergoing ileal pouch–anal anastomosis (IPAA, or “J-pouch”) surgery by sharing evidence-based best practices.
What is IPAA (J-pouch) surgery?
Ileal pouch–anal anastomosis (IPAA) is a restorative operation that removes the diseased colon and rectum and builds an internal pouch from the end of the small intestine, allowing patients — most often those with ulcerative colitis or familial adenomatous polyposis — to pass stool normally without a permanent ostomy.
Why do surgeon experience and hospital volume matter for pouch surgery?
Outcomes after IPAA improve with surgeon and hospital experience: higher-volume centers generally report fewer complications and better long-term pouch function. The consortium highlights this volume–outcome relationship to help patients and referring physicians identify experienced centers.
What are the main threats to pouch surgery quality?
The consortium identifies declining case volumes, erosion of surgical experience, unwarranted variation in technique, complications such as pelvic sepsis, and online misinformation as key threats to consistent, high-quality pouch surgery.
Who is iPouch.org for?
iPouch.org serves surgeons and researchers (curated evidence, quality metrics, and collaboration) as well as patients (plain-language guidance and trusted resources) across the global pouch-surgery community.
Curated Pouch Research
Nordenvall et al., Colorectal Dis 2025 — Chance of pouch surgery after colectomy for UC based on pelvic pouch volumes at the colectomy hospital. Swedish national cohort showing patients at low-volume hospitals were half as likely to receive pouch reconstruction after colectomy for UC.1
Giddings et al., ANZ J Surg 2024 — High but decreasing rates of reconstruction after total proctocolectomy for UC, and evidence of a direct volume outcome relationship. New South Wales analysis of 1,047 patients showing low-volume centres had adjusted hazard ratio of 0.60 for reconstruction. Rates declining from 2001–2019.2
Worley et al., Colorectal Dis 2018 — Restorative surgery after colectomy for ulcerative colitis in England and Sweden. Population-based comparison of 98,691 patients showing 5-year reconstruction rates of 33% in England vs 46% in Sweden, highlighting international disparities.3
Hoang et al., J Gastrointest Surg 2019 — Distribution of elective ileal pouch-anal anastomosis cases for ulcerative colitis. Nearly half of all IPAA cases in the U.S. were performed at just 10 of 131 hospitals. Most academic centers performed fewer than 5 cases per year.4 Violante et al., Ann Surg 2025 — Individualized Learning in Robotic Ileal Pouch-Anal Anastomosis: Challenging the Standard Learning Curve Model. Multi-site analysis of 123 robotic IPAAs by 11 surgeons using risk-adjusted CUSUM, demonstrating highly individualized learning trajectories that challenge the concept of a uniform learning curve.5 Steinhagen et al., Dis Colon Rectum 2025 — Optimal Pouch Training: Investigating Operative and Nonoperative Needs Study (OPTIONN). Modified Delphi consensus of 85 colorectal surgeons defining a supplemental curriculum for IPAA surgical training, addressing the growing experience gap.6 Obi & Holubar, Dis Colon Rectum 2024 — Ileoanal Pouch Construction for IBD. Illustrated technical guide to ileoanal pouch construction for inflammatory bowel disease, covering surgical approach, pouch configuration, and key operative steps.7 Celentano & Manzo, Colorectal Dis 2023 — Ten steps for ileoanal pouch anastomosis. Modular 10-step standardised framework for laparoscopic IPAA, designed to facilitate introduction of the technique during the learning curve. 38 consecutive patients, 34% complication rate.8
Kotze et al., Clin Colon Rectal Surg 2021 — Training for Minimally Invasive Surgery for IBD: A Current Need. Review outlining the importance of specialised surgical training in MIS for IBD, discussing multiport laparoscopy, single-port, robotics, and transanal platforms. Emphasises the lack of IBD-specific training protocols and the need for better training within multidisciplinary IBD centres.9 Rencuzogullari et al., Surg Endosc 2016 — Characteristics of learning curve in minimally invasive ileal pouch-anal anastomosis in a single institution. Cleveland Clinic series of 372 laparoscopic IPAAs by 20 surgeons. Institutional pelvic sepsis decreased from 18.2% to 7.0% (CUSUM peak at 143 cases). Learning curves identified in high-volume but not low-volume surgeons.10 Tekkis et al., Ann Surg 2005 — Evaluation of the learning curve in ileal pouch-anal anastomosis surgery. Landmark study of 1,965 IPAAs by 12 surgeons at Cleveland Clinic using risk-adjusted CUSUM. Training period of 23 cases for stapled IPAA (trainees) vs 40 cases (senior staff). 5-year pouch survival 95.6%.11
Moojen et al., Ann Surg Open 2025 — One-year stoma-free survival of ileoanal pouches for UC in European centers: The MIRACLE project. European multicenter study (NL, Belgium, Italy, UK) of 411 patients with 92.2% stoma-free survival at 1 year. High-volume centres showed OR 3.7 for better outcomes.12 Giddings et al., Br J Surg 2024 — Influence of hospital-level and surgeon factors on outcomes after ileo-anal pouch surgery for IBD: systematic review. Systematic review of 29 studies (41,344 patients) demonstrating higher pouch failure in lower-volume centres and higher reconstruction rates in higher-volume centres.13 Giddings et al., Colorectal Dis 2024 — Unexpected variation in outcomes following total (procto)colectomies for UC in New South Wales, Australia. Population-based 19-year study revealing significant variation in mortality by hospital volume, insurance status, and geography across New South Wales.14
Kennedy et al., Dis Colon Rectum 2006 — Increased experience and surgical technique lead to improved outcome after ileal pouch-anal anastomosis: a population-based study. Ontario study of 1,285 IPAAs across 58 hospitals demonstrating 4–5× higher reoperation and pouch excision rates at low-volume centres. A landmark early volume-outcome study.15 Worley et al., Colorectal Dis 2018 — Review of current practice and outcomes following ileoanal pouch surgery: lessons learned from the Ileoanal Pouch Registry and the 2017 Pouch Report. Analysis of 5,352 pouches across 76 UK centres and 154 surgeons from the ACPGBI Ileoanal Pouch Registry, establishing national benchmarks for pouch surgery outcomes.16 Worley, Colorectal Dis 2026 — Ileoanal pouch surgery in 2026. Contemporary perspective on the state of pouch surgery, addressing institutional variation, standards of care, and the future direction of IPAA practice.17 Peponis et al., Dis Colon Rectum 2024 — Trends and distribution of ileal pouch-anal anastomoses in the United States: becoming harder to find in colon and rectal surgery residency training? Analysis showing a mean of fewer than 6 IPAA cases per surgical resident, with a shift toward urban-teaching hospitals and growing training concerns.18 Hashash et al., Crohns Colitis 360 2023 — Ethnic variation trends in the use of ileal pouch-anal anastomosis in patients with ulcerative colitis. National Inpatient Sample study revealing that Black patients were significantly less likely to undergo IPAA compared to other ethnic groups, highlighting disparities in surgical access.19 Deputy et al., Colorectal Dis 2022 — Editorial: Regionalisation of ileoanal pouch surgery. Editorial discussing the rationale and implications of centralizing pouch surgery to high-volume centres to improve patient outcomes.20 Kröner et al., Colorectal Dis 2021 — The use of ileal pouch-anal anastomosis in patients with ulcerative colitis from 2009 to 2018. National Inpatient Sample analysis documenting temporal trends in IPAA utilization over a decade, providing context for declining pouch procedure rates nationally.21 Holubar et al., Dis Colon Rectum 2026 — IPAA-SONAR: Synoptic Operative Note and Reporting After Ileoanal Pouch Surgery — A Modified Delphi Consensus by the ASCRS IBD Committee. Delphi consensus establishing standardized synoptic operative reporting elements for IPAA surgery, enabling quality measurement and benchmarking.23
Morita et al., Dis Colon Rectum 2026 — Textbook Outcome after ileal pouch-anal anastomosis for ulcerative colitis: a nationwide multicenter study. Japanese multicenter study (Keio University) of 1,109 patients introducing the "Textbook Outcome" composite measure, achieved in 57% of IPAA cases.24 Celentano et al., Surgery 2022 — Standardization of ileoanal J-pouch surgery technique: quality assessment of minimally invasive ileoanal J-pouch surgery videos. Structured video-based assessment tool scoring the quality and standardization of minimally invasive IPAA operative videos, developed with an international expert panel to benchmark surgical technique.25 Morar et al., J Crohns Colitis 2017 — Establishing Key Performance Indicators and Their Importance for the Surgical Management of Inflammatory Bowel Disease. Pan-European Delphi consensus of 21 experts defining procedure-specific KPIs for IBD surgery including IPAA, covering morbidity, mortality, and service provision standards.26Curated Provider Resources
Pouch Guidelines
Kayal et al., 2025 — ECCO topical review on pouch disorders. Comprehensive ECCO review covering pouchitis epidemiology, diagnostic criteria, acute and chronic management, Crohn’s-like disease of the pouch, cuffitis, and pouch failure.27 Barnes et al., 2024 Full Text — AGA clinical practice guideline on the management of pouchitis and inflammatory pouch disorders. AGA guideline on pouchitis classification, endoscopic and histologic diagnosis, antibiotic and biologic therapy, and indications for pouch excision.28ASCRS — American Society of Colon and Rectal Surgeons
Holubar et al., 2021 — The American Society of Colon and Rectal Surgeons clinical practice guidelines for the surgical management of ulcerative colitis. Comprehensive surgical guidelines covering indications for colectomy, timing of surgery, IPAA technique, and management of complications. Updated 2021.ACG — American College of Gastroenterology
Rubin et al., 2019 — ACG clinical guideline: ulcerative colitis in adults. Comprehensive medical management guideline covering diagnosis, assessment of disease severity, therapeutic approach including biologics and small molecules, and surgical indications.29AGA — American Gastroenterological Association
Singh et al., 2025 Full Text — AGA living guideline for pharmacological management of moderate-to-severe ulcerative colitis. AGA living guideline incorporating the latest evidence on biologics, small molecules, treat-to-target strategies, and positioning of advanced therapies for moderate-to-severe UC management.30 Feuerstein et al., 2020 — AGA clinical practice guidelines on the management of moderate to severe ulcerative colitis. Guideline addressing biologic and small molecule therapy selection, positioning, and combination strategies for moderate-to-severe UC. Ko et al., 2019 — AGA clinical practice guidelines on the management of mild-to-moderate ulcerative colitis. Evidence-based recommendations for outpatient management of mild-to-moderate UC including 5-ASA optimization, immunomodulators, and step-up therapy.31ECCO — European Crohn’s and Colitis Organisation
Gisbert et al., 2026 — ECCO guidelines on therapeutics in ulcerative colitis: medical treatment. Updated 2026 European evidence-based consensus on UC medical management, incorporating the latest biologics, small molecules, JAK inhibitors, treat-to-target strategies, and positioning of advanced therapies.32 Adamina et al., 2026 — ECCO guidelines on therapeutics in ulcerative colitis: surgical treatment. Updated 2026 European consensus on surgical indications, timing of colectomy, IPAA technique, pouch configuration, and management of surgical complications in UC.iPouch.org Calculators
PSC-Dysplasia Risk Calculator
IBD-PSC IRA Rectal Cancer Risk Calculator
Curated External Calculators
IBD Advanced Colorectal Neoplasia Risk Tool
CCF Risk Calculators — including IBD Pouch Retention
UC Colectomy Risk Prediction Tool
UC Relapse Risk Calculator
Mayo Score / Disease Activity Index (DAI) for UC
ACS NSQIP Surgical Risk Calculator
IGIBD Calculators in Gastroenterology
IBD Training & Milestones
DDI CME — IBD Training — IBD Milestones Curriculum. Digestive Disease Interventions CME curriculum on IBD training milestones—structured educational content for fellows and trainees covering core competencies in IBD care. The IBD Project — Education — The IBD Project Educational Resources. Educational platform offering curated IBD learning content for clinicians and trainees—modules, case discussions, and resources advancing IBD-specific competencies. Crohn’s & Colitis Foundation — Advanced IBD Fellowship Support Program — Advanced IBD Fellowship Support Program. CCF program supporting advanced IBD fellowship training across the U.S.—sponsoring fellows pursuing dedicated IBD expertise, with curriculum guidance, mentorship, and program directory. Cleveland Clinic — Advanced IBD Fellowship — Advanced Inflammatory Bowel Disease Fellowship. Cleveland Clinic Digestive Disease & Surgery Institute advanced fellowship for gastroenterologists pursuing subspecialty training in IBD—clinical, endoscopic, and research preparation for academic IBD careers. Cleveland Clinic — APP IBD Fellowship — Advanced Practice Provider Inflammatory Bowel Disease Fellowship. Cleveland Clinic Digestive Disease & Surgery Institute fellowship for nurse practitioners and physician assistants pursuing specialized training in IBD care—structured curriculum, mentorship, and hands-on clinical experience. IBDIQ — IBDIQ — HCP IBD Education Resource. Industry-supported (Takeda) educational platform for healthcare professionals managing IBD—clinical resources, treatment updates, and disease-state information for gastroenterologists and IBD care teams.
IBD-EII — IBD-EII — Inflammatory Bowel Disease Educational Platform. European/Spanish-language educational resource for clinicians caring for patients with inflammatory bowel disease (Enfermedad Inflamatoria Intestinal)—clinical content, treatment updates, and disease-state education.
ChatIBD
ChatIBD is an AI-powered clinical companion designed by IBD clinicians, focused on medical care of IBD—advanced medical therapies, positioning and dosing, and surveillance—with guideline-based answers in seconds.
Designed for gastroenterologists, IBD specialists, nurses, allied health professionals, and trainees.
IBD EII
IBD EII (enfermedad inflamatoria intestinal) is a Spanish-language IBD education platform focused on clinical trials, meta-analyses, and guidelines—evidence updates for the Spanish-speaking IBD community.
IOIBD
GETAID
TopCLASS
NSQIP-IBD Collaborative
Crohn’s & Colitis Foundation IBD SIRQC
Evidence-based Information for Patients & Resources
Life With a Pouch AI-Powered
The ileal pouch-anal anastomosis (IPAA or “J-pouch”) is a common reconstructive option after proctocolectomy for ulcerative colitis. The following general overview was generated by Pouchology.org Artificial Intelligence from published literature. Individual experiences vary—discuss your specific situation with your care team.
AI-Written · Not Clinician-Verified
Bowel Function
Bowel habits vary, but many patients report multiple soft or liquid bowel movements per day, including at night. Patterns often improve over the first year.33
Continence
Most patients report good daytime continence. Some may experience minor nighttime seepage, particularly in the early postoperative period.33
Diet
Many patients are able to eat a varied diet. Your doctor may recommend periodic nutritional monitoring based on your individual needs.36,37
Activity
Many patients return to full activity, including work and exercise, after recovery. The timeline varies by individual.33
Sexual Function & Fertility
Pelvic surgery may affect sexual function and fertility in some patients. If this is a concern, early discussion with your surgical and medical team is encouraged.34
Pouchitis
Inflammation of the pouch (pouchitis) is a recognized complication that can occur at any time. It is generally treatable. Discuss symptoms with your GI doctor.28
Pouch Survival
Published long-term data suggest that most pouches function well over many years. Revisional surgery may be an option in some cases.33
Quality of Life
Studies generally report that most pouch patients rate their quality of life as good to excellent and would make the same surgical choice again.33
Before Pouch Surgery — Talk-Through Checklist
Pouch surgery is a big decision. Talk through the topics below with your care team. Plan to have at least two visits before you decide. Print this page or bring it to your visits. Check off each item once you have talked it through.
Why a pouch is being suggested
Your diagnosis (such as ulcerative colitis or FAP). What other treatments could work. Why your team thinks a pouch is the best next step.39
Number of surgeries
Whether you will need 1, 2, or 3 surgeries. Why your team chose that plan. How long between each one.39
How the surgery is done
Will the team use small cuts (keyhole or robot) or one larger cut? Why your team picked that way.39
Pouch shape
The shape of the pouch (most often a J-pouch). How the pouch will be joined to your bottom.39
Short-term ostomy
Whether you will need an ostomy bag for a few months. How long it stays. What daily life with a bag is like.39
Your care team
Who is on your team besides your surgeon. The team may include a GI doctor, a nurse, an ostomy nurse, a dietitian, and a psychologist. How to reach each of them.39
How often you go
How many times a day and night you may go to the bathroom with a pouch. How this may change in the first year.33
Bowel control
What bowel control will be like during the day and at night. What to do if there are accidents.33
Pouchitis
Pouchitis means the pouch gets sore and inflamed. It is common. How to spot it. How it is treated.28
If the pouch does not work
Sometimes a pouch does not work in the long run. What other choices you would have. What life with a permanent ostomy is like.33
Life-long check-ups
You will need a small camera test of the pouch each year or two. This keeps the pouch healthy.35
Fertility and sex life
This surgery may make it harder to get pregnant, more so for women. Sex life may also change. Talk about family planning early.34
Eating and food
How to eat well before surgery. What eating is like after each surgery. When to ask a dietitian for help.36
Mental health
This is a big life change. Mental support is part of good care. How to find a counselor or psychologist on your team.38
Two or more visits
Do not decide in one visit. Take your time. Write down questions. Come back to talk again.39
Patient Voices
Stories and reflections from people living with a J-pouch. Hearing from patients who have been through pouch surgery can help set expectations and offer perspective on what daily life can look like.
Pravin Ruparelia — The World’s First Pouch Patient (1976)
The very first IPAA, told through his son. Sir Alan Parks’ original operation.
“My J-Pouch Changed My Life”
Five patients and a surgeon share their stories—the good, the hard, and the real.
“Yes I Have a J-Pouch, Yes I Still Have IBD”
A pouch is a treatment, not a cure. Setting honest expectations.
Shannon Kederis — “J-Pouch Surgery Gave Me My Life Back”
A two-month hospitalization, a revision at Cleveland Clinic, and a pouch that finally works.
Red Lion Group — Patient Stories Archive
Decades of UK pouch narratives: marathon finishers, 42-year pouches, and professionals who thought they’d never work again.
Alwine Jarvis — “My J-Pouch Surgery Story”
Thirty years of UC, then a laparoscopic two-stage IPAA.
“Complications With My J-Pouch”
An honest account of a pouch that didn’t work out, and the decision to move to a permanent ileostomy.
Health Maintenance for Pouch Patients AI-Powered
Living well after IPAA means staying engaged with your healthcare team. Talk to your doctors about a personalized plan that addresses the areas below.
AI-Written · Not Clinician-Verified
Your Care Team
Pouch patients benefit from coordinated care between a colorectal surgeon, gastroenterologist, and primary care provider. Regular follow-up with each ensures nothing falls through the cracks.38
Pouch Surveillance
Periodic endoscopic evaluation of the pouch and rectal cuff may be part of long-term care. Your GI doctor can recommend a schedule based on your individual risk factors.35
Nutritional Health
Pouch patients may be at risk for certain nutritional deficiencies. Periodic blood work can help identify and address these. Ask your doctor what monitoring makes sense for you.36
Bone Health
Factors such as prior steroid use and chronic inflammation may affect bone density over time. Bone density testing, calcium, vitamin D, and weight-bearing exercise are topics to discuss with your care team.38
Kidney Health
Changes in fluid absorption after pouch surgery may affect kidney health. Adequate hydration and periodic monitoring are topics to discuss with your doctor.37
Fertility & Pregnancy
Pelvic surgery may affect fertility in some patients. If family planning is a consideration, early conversation with your doctors can be helpful.34
Vaccinations
Patients on certain medications may need to discuss their immunization plan with their care team, as some vaccines may need to be adjusted.38
Cancer Screening
In addition to standard age-appropriate cancer screenings, your doctor may recommend additional surveillance based on your individual risk profile.35,38
Mental Well-Being
Living with a chronic condition can take an emotional toll. Peer support groups, counseling, and open conversations with your care team are all options worth exploring.38
Bottom Line
Health maintenance after IPAA is a partnership between you and your care team. Discuss which of these areas apply to your individual situation.38
Support & Community
J-Pouch
Monthly virtual peer-support group for J-pouch patients, hosted by the Crohn’s & Colitis Foundation. Meets the 1st Thursday of each month at 7 p.m. ET. Email ccjpouch@myibdsupport.org to join.
Patient-run community with forums for general discussion, pouchitis, diet, and peer support from fellow pouch patients.
Active Facebook community where pouch patients share experiences, ask questions, and offer peer support.
UK-based charity run by volunteers with guidance from St. Mark’s Hospital. Support and information for people with internal ileo-anal pouches and those considering pouch surgery.
UK and Ireland charity supporting people with ileostomies and internal pouches for 60+ years. Local volunteer groups, one-to-one peer support matching, online forums (IA Together), and dedicated pouch education.
United Ostomy Associations of America page on J-pouch surgery, with links to support groups, emotional support, diet, and travel tips.
Ileostomy
Search for local ostomy and J-pouch support groups across the United States.
Practical guidance on daily life with an ostomy, including skin care, diet, sexuality, travel, and product information.
Wound, Ostomy & Continence Nurses Society directory. Find a specialized nurse for ostomy and pouch care.
IBD Community
Long-running, patient-run online community and discussion forum for people living with IBD — candid peer support, shared experiences, and Q&A among Crohn’s disease and ulcerative colitis patients.
Listing of external resources does not imply endorsement by the iPouch Consortium. These organizations are independent. Always verify information with your own healthcare team.
Medical Societies
Comprehensive patient guide to UC: symptoms, diagnosis, medications, surgery options, and living with the disease.
American Society of Colon and Rectal Surgeons patient education page on UC, including surgical options and what to expect. Available in English, Spanish, and Mandarin.
ASCRS patient guide to ostomies: types, care, daily living, and what to expect after surgery.
American Gastroenterological Association patient page on UC with treatment information and links to the IBD Drug Guide.
American College of Gastroenterology patient overview of UC, including a downloadable guidebook and educational video.
Interactive AGA resource for patients living with IBD: tracking tools, support resources, and treatment information.
Patient-friendly guide to IBD medications: how they work, side effects, and what to discuss with your doctor.
European Crohn’s and Colitis Organisation interactive guide to IBD clinical guidelines and patient information.
Links to medical society resources are provided for informational purposes only. No endorsement is implied or intended. These organizations are independent.
References
The peer-reviewed evidence behind iPouch.org, cited in order of appearance across the site.
- Risto A, Myrelid P, Söderling J, Olén O, Nordenvall C. Chance of pouch surgery after colectomy for ulcerative colitis based on pelvic pouch volumes at the colectomy hospital, a Swedish national cohort study. Colorectal Dis. 2025;27(9):e70234. PMID: 40958388.
- Giddings HL, Ng KS, Solomon MJ, Steffens D, Van Buskirk J, Young J. High but decreasing rates of reconstruction after total proctocolectomy for ulcerative colitis, and evidence of a direct volume outcome relationship. ANZ J Surg. 2024;94(9):1598-1609. PMID: 38525855.
- Worley G, Nordenvall C, Askari A, Pinkney T, Burns E, Akbar A, Olén O, Ekbom A, Bottai M, Myrelid P, Faiz O. Restorative surgery after colectomy for ulcerative colitis in England and Sweden: observations from a comparison of nationwide cohorts. Colorectal Dis. 2018;20(9):804-812. PMID: 29603863.
- Hoang CM, Maykel JA, Davids JS, Crawford AS, Sturrock PR, Alavi K. Distribution of Elective Ileal Pouch-Anal Anastomosis Cases for Ulcerative Colitis: a Study Utilizing the University Health System Consortium Database. J Gastrointest Surg. 2019;24(11):2613-2619. PMID: 31768826.
- Violante T, Ferrari D, Sassun R, Behm KT, Mishra N, Merchea A, Vierkant RA, Larson DW. Individualized Learning in Robotic Ileal pouch-anal anastomosis: Challenging the Standard Learning Curve Model. Ann Surg. 2025. PMID: 40792635.
- Steinhagen E, Stein SL, Ofshteyn A, Sherman KL, Miller-Ocuin JL, Fennern EB, Bordeianou LG. Optimal Pouch Training: Investigating Operative and Nonoperative Needs Study. Dis Colon Rectum. 2025;68(6):764-775. PMID: 40044400.
- Obi M, Holubar SD. Ileoanal Pouch Construction for IBD. Dis Colon Rectum. 2024;67(6):748-752. PMID: 38441144.
- Celentano V, Manzo CA. Ten steps for ileoanal pouch anastomosis. Colorectal Dis. 2023;25(10):2093-2096. PMID: 37583048.
- Kotze PG, Holubar SD, Lipman JM, Spinelli A. Training for Minimally Invasive Surgery for IBD: A Current Need. Clin Colon Rectal Surg. 2021;34(3):172-180. PMID: 33814999.
- Rencuzogullari A, Stocchi L, Costedio M, Gorgun E, Kessler H, Remzi FH. Characteristics of learning curve in minimally invasive ileal pouch-anal anastomosis in a single institution. Surg Endosc. 2016;31(3):1083-1092. PMID: 27412123.
- Tekkis PP, Fazio VW, Lavery IC, Remzi FH, Senagore AJ, Wu JS, Strong SA, Poloneicki JD, Hull TL, Church JM. Evaluation of the learning curve in ileal pouch-anal anastomosis surgery. Ann Surg. 2005;241(2):262-8. PMID: 15650636.
- Moojen TB, Visser E, Reijntjes MA, Lange JF, Bislenghi G, Carvello M, Warusavitarne J, Hompes R, Stassen LPS, Faiz OD, Spinelli A, D'Hoore A, Bemelman WA. One-year stoma-free survival of ileoanal pouches for UC in European centers: The MIRACLE project. Ann Surg Open. 2025;6(3):e596. PMID: 40989865.
- Giddings HL, Yang PF, Steffens D, Solomon MJ, Ng KS. Influence of hospital-level and surgeon factors on the outcomes after ileo-anal pouch surgery for inflammatory bowel disease: systematic review. Br J Surg. 2024;111(5). PMID: 38740552.
- Giddings HL, Ng KS, Solomon MJ, Steffens D, Van Buskirk J, Young J. Unexpected variation in outcomes following total (procto)colectomies for ulcerative colitis in New South Wales, Australia: a population-based 19-year linked-data study. Colorectal Dis. 2024;26(8):1584-1596. PMID: 38937922.
- Kennedy ED, Rothwell DM, Cohen Z, McLeod RS. Increased experience and surgical technique lead to improved outcome after ileal pouch-anal anastomosis: a population-based study. Dis Colon Rectum. 2006;49(7):958-65. PMID: 16703449.
- Worley GHT, Fearnhead NS, Brown SR, Acheson AG, Lee MJ, Faiz OD. Review of current practice and outcomes following ileoanal pouch surgery: lessons learned from the Ileoanal Pouch Registry and the 2017 Ileoanal Pouch Report. Colorectal Dis. 2018;20(10):913-922. PMID: 29927537.
- Worley G. Ileoanal pouch surgery in 2026. Colorectal Dis. 2026;28(1):e70352. PMID: 41457331.
- Peponis T, Ubl DS, Habermann EB, Abarca Rendon FM, McKenna NP, Ofshteyn A, Mathis KL, Colibaseanu DT, Kelley SR. Trends and Distribution of IPAAs in the United States: Becoming Harder to Find in Colon and Rectal Surgery Residency Training?. Dis Colon Rectum. 2024;67(8):1040-1047. PMID: 39019562.
- Hashash JG, Mourad FH, Odah T, Farraye FA, Kroner P, Stocchi L. Ethnic Variation Trends in the Use of Ileal Pouch-Anal Anastomosis in Patients With Ulcerative Colitis. Crohns Colitis 360. 2023;5(4):otad072. PMID: 38034883.
- Deputy M, Celentano V, Faiz O. Editorial: Regionalisation of ileoanal pouch surgery. Colorectal Dis. 2022;24(3):253-254. PMID: 35391508.
- Kröner PT, Merchea A, Colibaseanu D, Picco MF, Farraye FA, Stocchi L. The use of ileal pouch-anal anastomosis in patients with ulcerative colitis from 2009 to 2018. Colorectal Dis. 2021;24(3):308-313. PMID: 34743378.
- Holubar SD, et al. (KPIPS International Consensus Group) Defining quality pouch surgery — a critical step towards centralisation? International consensus on key performance indicators in pouch surgery (KPIPS). J Crohns Colitis. 2026 (in press). Full text.
- Holubar SD, et al. IPAA-SONAR: synoptic operative note and reporting after ileoanal pouch surgery — a modified Delphi consensus by the ASCRS IBD Committee. Dis Colon Rectum. 2026 (in press). Full text.
- Morita S, Okabayashi K, Kitagawa Y, Okita Y, Ochi S, Inomata M, Okada T, Akamoto S, Kuwabara H, Naitoh T. Textbook Outcome After IPAA for Ulcerative Colitis: A Nationwide Multicenter Study and Its Implications for Long-term Quality of Life. Dis Colon Rectum. 2026;69(6):1688-1696. PMID: 41685680.
- Celentano V, Tekkis P, Nordenvall C, Mills S, Spinelli A, Smart N, Selvaggi F, Warren O, Espin-Basany E, Kontovounisios C, Pellino G, Warusavitarne J, Hancock L, Myrelid P, Remzi F. Standardization of ileoanal J-pouch surgery technique: Quality assessment of minimally invasive ileoanal J-pouch surgery videos. Surgery. 2021;172(1):53-59. PMID: 34980484.
- Morar PS, Hollingshead J, Bemelman W, Sevdalis N, Pinkney T, Wilson G, Dunlop M, Davies RJ, Guy R, Fearnhead N, Brown S, Warusavitarne J, Edwards C, Faiz O. Establishing Key Performance Indicators [KPIs] and Their Importance for the Surgical Management of Inflammatory Bowel Disease-Results From a Pan-European, Delphi Consensus Study. J Crohns Colitis. 2017;11(11):1362-1368. PMID: 28961891.
- Kayal M, Bislenghi G, Adamina M, Ardalan ZS, Avellaneda N, de Buck van Overstraeten A, Duijvestein M, Estevinho MM, Furfaro F, Hart AL, Holubar S, Lobaton T, Ollech J, Vavricka SR, Ferrante M. ECCO Topical Review on Pouch Disorders. J Crohns Colitis. 2025;19(7). PMID: 40574702.
- Barnes EL, Agrawal M, Syal G, Ananthakrishnan AN, Cohen BL, Haydek JP, Al Kazzi ES, Eisenstein S, Hashash JG, Sultan SS, Raffals LE, Singh S. AGA Clinical Practice Guideline on the Management of Pouchitis and Inflammatory Pouch Disorders. Gastroenterology. 2024;166(1):59-85. PMID: 38128971.
- Rubin DT, Ananthakrishnan AN, Siegel CA, Sauer BG, Long MD. ACG Clinical Guideline: Ulcerative Colitis in Adults. Am J Gastroenterol. 2019;114(3):384-413. PMID: 30840605.
- Singh S, Loftus EV, Limketkai BN, Haydek JP, Agrawal M, Scott FI, Ananthakrishnan AN. AGA Living Clinical Practice Guideline on Pharmacological Management of Moderate-to-Severe Ulcerative Colitis. Gastroenterology. 2024;167(7):1307-1343. PMID: 39572132.
- Ko CW, Singh S, Feuerstein JD, Falck-Ytter C, Falck-Ytter Y, Cross RK. AGA Clinical Practice Guidelines on the Management of Mild-to-Moderate Ulcerative Colitis. Gastroenterology. 2018;156(3):748-764. PMID: 30576644.
- Gisbert JP, Chaparro M, Verstockt B, Kienle P, Minozzi S, Allocca M, Atreya R, Avellaneda N, Barreiro-de Acosta M, Battat R, Bettenworth D, Blumenstein I, Brown SR, Burke JP, Caprioli F, Casanova MJ, Christou N, de Buck van Overstraeten A, Doherty G, Eder P, El-Hussuna A, Ellul P, Fantini MC, Furfaro F, Greuter T, Hazel K, Holubar S, Kapizioni C, Kopylov U, Leong RW, Leventoglu S, Limdi JK, Noor NM, Papaconstantinou I, Peros G, Pouillon L, Reenaers C, Saibeni S, Schmidt C, Sousa P, Stassen LPS, Uzzan M, Vieujean S, Visser E, Myrelid P, Adamina M, Kucharzik T. ECCO Guidelines on Therapeutics in Ulcerative Colitis: Medical Treatment. J Crohns Colitis. 2026;20(7). PMID: 42413123.
- Fazio VW, Kiran RP, Remzi FH, Coffey JC, Heneghan HM, Kirat HT, Manilich E, Shen B, Martin ST. Ileal pouch anal anastomosis: analysis of outcome and quality of life in 3707 patients. Ann Surg. 2013;257(4):679-85. PMID: 23299522.
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Sponsors
Coming Soon
Sponsors & Partners
Information about consortium sponsors and partnership opportunities will be available here. iPouch.org welcomes industry partners who share our commitment to improving pouch surgery outcomes worldwide.
For sponsorship inquiries, please email webmaster@ipouch.org.
Contact
Contact iPouch.org
Interested in collaborating, learning more about the consortium, or have a question? We'd love to hear from you.
We typically respond within a few business days.
Converging Forces → Web of Threats to Pouch Surgery Quality
iPouch.org is an international quality improvement initiative bringing together leading IBD surgeons and IBD gastroenterologists from across the globe to advance the care of patients undergoing ileal pouch–anal anastomosis (IPAA).
Founded on global data showing an inverse relationship between institutional pouch volumes and adverse post-operative outcomes, iPouch.org provides a framework for collaborative benchmarking, dissemination of data-driven best practices, and continuous quality improvement.
Our mission is to ensure that every patient who needs a pouch receives the highest standard of surgical care, regardless of where they are treated.
Web of Threats to Pouch Surgery Quality
Converging Forces
Interconnected threats
Converging on crisis
Pouch Quality
Crisis
Crisis
Declining
Volumes
Efficacy of advanced medical therapy
Surgeon-Level
Variation
Individual experience impacts outcomes
Training Gap
Insufficient case volume during fellowship
Center-Level
Variation
Lower volumes raise complication rates
Access
Disparities
Geographic & insurance barriers
Pouch
Perceptions
Stigmatization on social media
© iPouch.org
Pouch surgery faces an unprecedented convergence of threats to quality. Declining IPAA rates—driven by the improved efficacy of new advanced medical therapies and patients choosing not to pouch—are reducing the number of procedures performed. This leads to declining surgeon, trainee, multidisciplinary team, and center experience with the operation and caring for pouch patients, especially when complications arise.
As experience erodes, complications rise, rescue operations fail, and pouch outcomes suffer, which in turn fuel negative patient experiences and IPAA stigmatization on social media, further discouraging patients from choosing pouch surgery. These four forces feed into each other in a positive feedback loop, creating a widening gap between high-volume pouch centers and low-volume centers.
Steering Committee
The iPouch Consortium steering committee brings together leading pouch specialists — surgeons and gastroenterologists — who have dedicated their professional careers to the care of pouch patients and IPAA research.
Colon & Rectal Surgery
Cleveland Clinic / CWRU, Cleveland
Cleveland Clinic / CWRU, Cleveland
Gastroenterology & Hepatology
University of North Carolina, Chapel Hill
University of North Carolina, Chapel Hill
Gastroenterology
Icahn School of Medicine at Mount Sinai, New York
Icahn School of Medicine at Mount Sinai, New York
Colon & Rectal Surgery
Atrium Health Wake Forest Baptist, Winston-Salem
Atrium Health Wake Forest Baptist, Winston-Salem
Global Liaisons
Global liaisons extending the iPouch Consortium’s collaborative network across countries and continents.
Australia & New Zealand
Professor of Surgery, Colorectal Surgery
Royal Brisbane & Women’s Hospital / University of Queensland, Brisbane
Royal Brisbane & Women’s Hospital / University of Queensland, Brisbane
Colorectal Surgery
Royal Prince Alfred Hospital, Sydney
Royal Prince Alfred Hospital, Sydney
Deputy Director, Colorectal Surgery
St Vincent’s Hospital, Melbourne
St Vincent’s Hospital, Melbourne
Europe
Gastroenterology
KU Leuven, Leuven
KU Leuven, Leuven
Antoine Brouquet, MD, PhDDigestive & Oncologic Surgery
Hôpital Bicêtre (AP-HP) / Paris-Sud
Hôpital Bicêtre (AP-HP) / Paris-Sud
Colorectal Surgery
Hôpital Saint-Antoine, Paris
Hôpital Saint-Antoine, Paris
Ronan O’Connell, MD, FRCSIColorectal Surgery
University College Dublin / St Vincent’s, Dublin
University College Dublin / St Vincent’s, Dublin
Colorectal Surgery
University of Naples Federico II, Naples
University of Naples Federico II, Naples
Colon & Rectal Surgery
Humanitas University, Milan
Humanitas University, Milan
Colorectal Surgery
Amsterdam UMC, Amsterdam
Amsterdam UMC, Amsterdam
Professor of Surgery, Colorectal Surgery
Linköping University Hospital, Linköping
Linköping University Hospital, Linköping
Colorectal Surgery
Karolinska Institute, Stockholm
Karolinska Institute, Stockholm
Colorectal Surgery, IBD & Intestinal Failure
Ersta IBD Centre / Karolinska Institutet, Stockholm
Ersta IBD Centre / Karolinska Institutet, Stockholm
Colorectal Surgery
Chelsea and Westminster Hospital, London
Chelsea and Westminster Hospital, London
Colorectal Surgery
St Mark’s Hospital, London
St Mark’s Hospital, London
Latin America
Nicolás Avellaneda, MD, PhDColorectal Surgery, IBD
CEMIC University Hospital, Buenos Aires
CEMIC University Hospital, Buenos Aires
Colorectal Surgery Unit, IBD
Pontifical Catholic University of Paraná (PUCPR), Curitiba
Pontifical Catholic University of Paraná (PUCPR), Curitiba
Felipe Bellomo Roth, MDColorectal Surgery
Santiago, Chile
Santiago, Chile
Middle East
Oded Zmora, MDColorectal Surgery
Shamir Medical Center, Israel
Shamir Medical Center, Israel
North America
Canada Regional Liaison
McGill University, Montréal
McGill University, Montréal
Gastroenterology
University of Ottawa / The Ottawa Hospital, Ottawa
University of Ottawa / The Ottawa Hospital, Ottawa
Specialty Liaisons
Bridging surgical, gastroenterological, and educational expertise across the iPouch network.
Social Media Liaison
Gastroenterology, Cleveland Clinic, Cleveland, OH
Gastroenterology, Cleveland Clinic, Cleveland, OH
Pouch Educational Liaison
Colon & Rectal Surgery
University Hospitals / Case Western Reserve, Cleveland
Colon & Rectal Surgery
University Hospitals / Case Western Reserve, Cleveland
Advanced Interventional GI Liaison
ERCP, EBD, and Insulated Needle Knife (iKN) therapy
Cleveland Clinic, Cleveland
ERCP, EBD, and Insulated Needle Knife (iKN) therapy
Cleveland Clinic, Cleveland
GI Pathology Liaison
Gastrointestinal & Hepatobiliary Pathology
Cleveland Clinic, Cleveland
Gastrointestinal & Hepatobiliary Pathology
Cleveland Clinic, Cleveland
GI Radiology Liaison
Abdominal & Body Imaging
Cleveland Clinic, Cleveland
Abdominal & Body Imaging
Cleveland Clinic, Cleveland
GI Radiology Liaison
Abdominal Imaging, MR Enterography
Mallinckrodt Institute / Washington University, St. Louis
Abdominal Imaging, MR Enterography
Mallinckrodt Institute / Washington University, St. Louis
David Gardinier, RDIBD Nutritional Liaison
Registered Dietitian, DDSI Nutrition
Cleveland Clinic, Cleveland
Registered Dietitian, DDSI Nutrition
Cleveland Clinic, Cleveland
IBD Nutritional Liaison
Clinical Nutrition, IBD & Prehabilitation
UCSF, San Francisco
Clinical Nutrition, IBD & Prehabilitation
UCSF, San Francisco
Jessica Woodford, PhDIBD Psychology Liaison
Health Psychology, IBD
Cleveland Clinic, Cleveland
Health Psychology, IBD
Cleveland Clinic, Cleveland
Jacqueline McHugh, RN, WOC-RNOstomy Liaison
Wound, Ostomy & Continence Nursing
Cleveland Clinic, Cleveland
Wound, Ostomy & Continence Nursing
Cleveland Clinic, Cleveland
Jessica Sankovic, PA-CAPP Liaison
Colon & Rectal Surgery, Physician Assistant
Cleveland Clinic, Cleveland
Colon & Rectal Surgery, Physician Assistant
Cleveland Clinic, Cleveland
Olivia Collins, MPAS, PA-CAPP Liaison
Colon & Rectal Surgery, Physician Assistant
Cleveland Clinic, Cleveland
Colon & Rectal Surgery, Physician Assistant
Cleveland Clinic, Cleveland
NSQIP Liaison
Colon & Rectal Surgery, NSQIP IBD Collaborative
UC San Diego Health, La Jolla
Colon & Rectal Surgery, NSQIP IBD Collaborative
UC San Diego Health, La Jolla
EIM Advisor
Gastroenterology, Cleveland Clinic, Cleveland
Gastroenterology, Cleveland Clinic, Cleveland
Administration
Operational coordination for the iPouch Consortium.
Rita Brienza, RNProgram Manager (Interim)
Cleveland Clinic, Cleveland
Cleveland Clinic, Cleveland
Stefan D. Holubar
MD, MS, FACS, FASCRS • Professor of Surgery • Case Western Reserve University and Cleveland Clinic Lerner College of MedicineStefan Holubar brings a unique perspective to pouch surgery: he is both a fellowship-trained colorectal surgeon specializing in ileal pouch procedures and himself a pouch patient. This dual lived experience—from both sides of the operating table—drives his commitment to ensuring that every patient who needs a pouch receives the highest quality of care. He is also a clinician-informatician who designs and builds the Consortium's digital tools himself.