Curated Pouch Research

Moojen et al., 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.

Nordenvall et al., 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.

Giddings et al., 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.

Hoang et al., 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.

Worley et al., 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.

Giddings et al., 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.

Giddings et al., 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.

Worley et al., 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.

Kennedy et al., 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.

Worley, 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.

Peponis et al., 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.

Hashash et al., 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.

Deputy et al., 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.

Kröner et al., 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.

Quality Improvement

Morita et al., 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.

Morar et al., 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.

Violante et al., 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.

Steinhagen et al., 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.

Obi & Holubar, 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.

Celentano & Manzo, 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.

Kotze et al., 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.

Rencuzogullari et al., 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.

Tekkis et al., 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%.

Curated 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.

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.

ASCRS — 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.

AGA — 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.

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.

ECCO — European Crohn’s and Colitis Organisation

Raine et al., 2022

ECCO guidelines on therapeutics in ulcerative colitis: medical treatment

European evidence-based consensus on UC medical management including conventional therapy, biologics, JAK inhibitors, and treatment algorithms.

Spinelli et al., 2022

ECCO guidelines on therapeutics in ulcerative colitis: surgical treatment

European consensus on surgical indications, timing of colectomy, IPAA technique, pouch configuration, and management of surgical complications in UC.

iPouch.org Calculators

Coming Soon AI-Powered

PSC-Dysplasia Risk Calculator

Estimates cumulative risk of advanced colorectal neoplasia in IBD patients with primary sclerosing cholangitis (PSC), incorporating PSC status, disease duration, and surveillance history.

Coming Soon AI-Powered

IBD-PSC IRA Rectal Cancer Risk Calculator

Cox-Weibull model estimating mortality-adjusted rectal carcinoma risk after ileorectal anastomosis (IRA) in UC patients, with PSC as a key predictor. Four-predictor model with competing-risk adjustment.

Curated External Calculators

Defined Risk Group Tool, 2025

IBD Advanced Colorectal Neoplasia Risk Tool

Estimates 5-year risk of advanced colorectal neoplasia (HGD + CRC) in IBD patients. Developed from 6 international cohorts (3,731 patients, 26,336 patient-years). Complements 2025 BSG guidelines on colorectal surveillance in IBD.

Cleveland Clinic Risk Calculator Library

CCF Risk Calculators — including IBD Pouch Retention

Comprehensive library of clinical risk calculators developed by Cleveland Clinic physicians, including a tool predicting 7-year pouch retention probability after IPAA.

Dalal et al., 2019

UC Colectomy Risk Prediction Tool

Web-based tool predicting total proctocolectomy risk in UC using albumin, Mayo score, endoscopic subscore, and corticosteroid use. AUC 0.94 (validation 0.92).

Taher et al., 2023

UC Relapse Risk Calculator

Online calculator predicting 1-year relapse probability in UC patients currently in remission. Bilingual (English/Persian) tool from Shiraz University of Medical Sciences.

MDCalc

Mayo Score / Disease Activity Index (DAI) for UC

Standard disease activity calculator assessing UC severity (0–12 scale) using stool frequency, rectal bleeding, mucosal appearance, and physician global assessment.

ACS NSQIP

ACS NSQIP Surgical Risk Calculator

General surgical risk prediction tool from the American College of Surgeons. Note: validation studies suggest it may underestimate postoperative risks in IBD patients specifically.

IGIBD Scores

IGIBD Calculators in Gastroenterology

Collection of clinical and endoscopic scoring tools for IBD, including Rutgeerts score for post-surgical Crohn’s recurrence, Harvey-Bradshaw Index, and more.

Coming Soon

Carepaths

Standardized care pathways for pouch surgery patients, from preoperative optimization through long-term follow-up.

ChatIBD

ChatIBD is an AI-powered clinical companion designed by IBD clinicians. It provides quick, guideline-based answers to practical questions in IBD care—helping clinicians cut through lengthy documents and access key recommendations in seconds.

Designed for gastroenterologists, IBD specialists, nurses, allied health professionals, and trainees building familiarity with complex guidelines.

Visit ChatIBD.com →

Pouchology.org

Pouchology is an AI-powered retrieval-augmented generation (RAG) tool dedicated to all things pouch—providing clinicians with instant, evidence-based answers on pouch surgery, pouchitis, perioperative management, pouch failure, and patient care.

Visit Pouchology.org → AI-Powered Beta

© American College of Surgeons.
NSQIP® is a registered trademark of the ACS.

ACS NSQIP IBD Collaborative

The American College of Surgeons National Surgical Quality Improvement Program IBD Collaborative is a multi-center registry that adds disease-specific variables to NSQIP, enabling high-quality, large-volume research specific to the IBD surgical population. Currently enrolling across 17+ high-volume centers.

Led by Samuel Eisenstein, MD (UC San Diego Health)

© Crohn’s & Colitis Foundation.
Used with permission.

IBD SIRQC — Surgical Innovation, Research & Quality Collaborative

IBD SIRQC is the Crohn’s & Colitis Foundation’s first-ever surgical research initiative. This cohort study enrolls adults with Crohn’s disease or ulcerative colitis preparing for GI surgery and follows them through surgery and beyond, tracking long-term outcomes including complications and disease recurrence.

Co-led by Stefan D. Holubar, MD, MS (Cleveland Clinic) and Samuel Eisenstein, MD (UC San Diego Health)

Visit IBD SIRQC →

© TopCLASS Consortium.
topclass-ibd.com

TopCLASS — Consortium for Perianal Crohn’s Disease

TopCLASS is an international consortium focused on advancing the care of perianal Crohn’s disease. Active since 2022, fostering global collaboration to optimize medical and surgical treatment.

Led by Ailsa Hart, MD and Phil Tozer, MD (St. Mark’s Hospital, London)

Visit TopCLASS →

Disclaimer

The content on this page is for general educational purposes only. It is not medical advice and does not create a physician-patient relationship. Some content has been generated by artificial intelligence and has not been independently verified by a clinician. Individual outcomes vary. Always consult your own healthcare team before making any medical decisions.

For Patients

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.

Continence — Most patients report good daytime continence. Some may experience minor nighttime seepage, particularly in the early postoperative period.

Diet — Many patients are able to eat a varied diet. Your doctor may recommend periodic nutritional monitoring based on your individual needs.

Activity — Many patients return to full activity, including work and exercise, after recovery. The timeline varies by individual.

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.

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.

Pouch Survival — Published long-term data suggest that most pouches function well over many years. Revisional surgery may be an option in some cases.

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.

Patient Voices

“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.

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.

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.

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.

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.

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.

Fertility & Pregnancy — Pelvic surgery may affect fertility in some patients. If family planning is a consideration, early conversation with your doctors can be helpful.

Vaccinations — Patients on certain medications may need to discuss their immunization plan with their care team, as some vaccines may need to be adjusted.

Cancer Screening — In addition to standard age-appropriate cancer screenings, your doctor may recommend additional surveillance based on your individual risk profile.

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.

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.

Support & Community

Red Lion Pouch Support Group

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.

🌐 J-Pouch.org

Patient-run community with forums for general discussion, pouchitis, diet, and peer support from fellow pouch patients.

🌐 J-Pouch Facebook Group

Active Facebook community where pouch patients share experiences, ask questions, and offer peer support.

UOAA — J-Pouch Resources

United Ostomy Associations of America page on J-pouch surgery, with links to support groups, emotional support, diet, and travel tips.

UOAA Support Group Finder

Search for local ostomy and J-pouch support groups across the United States.

Find a WOC Nurse

Wound, Ostomy & Continence Nurses Society directory. Find a specialized nurse for ostomy and pouch care.

UOAA — Living with an Ostomy

Practical guidance on daily life with an ostomy, including skin care, diet, sexuality, travel, and product information.

Listing of external resources does not imply endorsement by the iPouch Consortium. These organizations are independent and not affiliated with iPouch.org. Always verify information with your own healthcare team.

Medical Society Links

Crohn’s & Colitis Foundation — Ulcerative Colitis

Comprehensive patient guide to UC: symptoms, diagnosis, medications, surgery options, and living with the disease.

ASCRS — Ulcerative Colitis

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 — Ostomy Information

ASCRS patient guide to ostomies: types, care, daily living, and what to expect after surgery.

AGA — Ulcerative Colitis

American Gastroenterological Association patient page on UC with treatment information and links to the IBD Drug Guide.

ACG — Ulcerative Colitis

American College of Gastroenterology patient overview of UC, including a downloadable guidebook and educational video.

AGA — My IBD Life

Interactive AGA resource for patients living with IBD: tracking tools, support resources, and treatment information.

AGA — IBD Drug Guide

Patient-friendly guide to IBD medications: how they work, side effects, and what to discuss with your doctor.

ECCO — e-Guide

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 and not affiliated with 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.

About

Mission Statement

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.

Threats to Pouch Surgery Quality

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.

iPouch.org was created to break this cycle—through collaborative benchmarking, evidence-based quality improvement, and ensuring that expertise in pouch surgery is preserved and shared globally.

Continue to Web of Threats →

Pouch surgery faces an unprecedented convergence of threats to quality. These six interconnected forces—from declining procedure rates and eroding surgical expertise to growing patient stigma—feed into each other in a positive feedback loop, threatening the future of reconstructive surgery for ulcerative colitis.

Web of Threats to Pouch Surgery Quality

Converging Forces

Interconnected threats

Converging on crisis

Pouch Quality
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

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.

Stefan D. Holubar, MD, MS

Colon & Rectal Surgery
Cleveland Clinic / CWRU, Cleveland

Edward L. Barnes, MD, MPH

Gastroenterology & Hepatology
University of North Carolina, Chapel Hill

Maia Kayal, MD

Gastroenterology
Icahn School of Medicine at Mount Sinai, New York

Jean H. Ashburn, MD

Colon & Rectal Surgery
Atrium Health Wake Forest Baptist, Winston-Salem

International Liaisons Committee

International liaisons extending the iPouch Consortium’s collaborative network across continents.

Caroline Nordenvall, MD, PhD

Colorectal Surgery
Karolinska Institute, Stockholm

Antonino Spinelli, MD, PhD

Colon & Rectal Surgery
Humanitas University, Milan

Hugh L. Giddings, MBBS, FRACS

Colorectal Surgery
Royal Prince Alfred Hospital, Sydney

Stefan D. Holubar

MD, MS, FACS, FASCRS • Professor of Surgery • Case Western Reserve University and Cleveland Clinic Lerner College of Medicine

Stefan 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.