EPD305 - IPAA-SONAR: Synoptic Operative Note and Reporting after Ileoanal Pouch Surgery – An ASCRS IBD Committee Modified Delphi Consensus Study

ePoster of Distinction Presenter(s)

• 

  Stefan D. Holubar, MD, MS, FACS, FASCRS

  Professor of Surgery; Director of Research
  Cleveland Clinic
  Case Western Reserve University
  Cleveland, OH, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no relevant relationships with ineligible companies.

Author(s)

• 

  Jean H. Ashburn, MD

  Associate Professor of Surgery
  Atrium Health Wake Forest Baptist
  Wake Forest Baptist Health
  Winston-Salem, NC, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no relevant relationships with ineligible companies.
• 

  Vitaliy Poylin, MD, MBA

  Director, Section of Colon and Rectal Surgery
  Northwestern University Feinberg School of Medicine
  Northwestern University Feinberg School of Medicine
  Chicago, IL, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• 

  Ali Alipouriani, MD

  Clinical Research Fellow
  Colorectal Surgery Department, Digestive Disease Institute, Cleveland Clinic Foundation
  Department of colorectal surgery, Cleveland Clinic Foundation
  Cleveland, OH, United States

  Disclosure information not submitted.
• MB

  Marcelo R. Borba, Vice president of Brasilian Society of Coloproctology

  physician in the coloproctology department at the University of São Paulo's Clinical Hospital
  University of Sao Paulo
  São Paulo, Sao Paulo, Brazil

  Disclosure information not submitted.
• BC

  Benjamin Click, MD, MS

  Assistant Professor
  University of Colorado
  Denver, Colorado, United States

  Disclosure information not submitted.
• BC

  Benjamin Cohen, MD

  Co-Section Head IBD
  Cleveland Clinic
  Shaker Heights, Ohio, United States

  Disclosure information not submitted.
• PD

  Parakkal Deepak, MD, MS

  Associate Professor of Medicine
  Washington University in St Louis School of Medicine
  St. Louis, Missouri, United States

  Disclosure information not submitted.
• 

  Jorge Luis De Leon Rendon, 7948396 (he/him/his)

  Coordinator and Founder, Inflammatory Bowel Disease Clinic
  Hospital General de México “Dr. Eduardo Liceaga”. Inflammatory Bowel Disease Clinic. Coloproctology Service.
  CDMX, Distrito Federal, Mexico

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no relevant relationships with ineligible companies.
• 

  Samuel Eisenstein, MD

  Professor
  UC San Diego Health
  UC San Diego Health
  La Jolla, CA, United States

  Disclosure information not submitted.
• 

  Alessandro Fichera, MD, FACS, FASCRS (he/him/his)

  Professor of Surgery Chief, Section of Colon and Rectal Surgery
  Weill Cornell Medicine
  Weill Cornell Medicine
  New York, NY, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• JF

  Jason Frischer, MD

  Surgeon-in-Chief, Chief of Pediatric Surgery
  Le bonheur Children's Hospital, University of Tennessee Health Science Center
  Memphis, Tennessee, United States

  Disclosure information not submitted.
• 

  Zoe Garoufalia, MD,PhD (she/her/hers)

  Colorectal Surgeon
  Hygeia Hospital
  Marousi, Attiki, Greece

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no relevant relationships with ineligible companies.
• 

  Charles P. Heise, MD, FACS, FASCRS

  Professor of Surgery
  University of Wisconsin, Madison
  Madison, Wisconsin, United States

  Disclosure information not submitted.
• AL

  Amy Lightner, MD, MBA (she/her/hers)

  Chief Medical Officer and Professor of Molecular Medicine
  Scripps Clinic and Scrips Research Institute
  Scripps Clinic
  La Jolla, CA, United States

  Disclosure information not submitted.
• MR

  Miguel Regueiro, MD

  Professor and Chief, Digestive Disease Institute
  Cleveland Clinic
  Cleveland, Ohio, United States

  Disclosure information not submitted.
• 

  Yesenia Rojas-Khalil, MD, FACS, FASCRS (she/her/hers)

  Assistant Professor of Surgery
  Baylor College of Medicine
  Houston, Texas, United States

  Disclosure information not submitted.
• JS

  Jeffrey S. Scow, MD, FACS, FASCRS

  Associate Professor of Surgery
  Milton S. Hershey Medical Center, Penn State Health
  Hershey, Pennsylvania, United States

  Disclosure information not submitted.
• 

  David M. Schwartzberg, MD, FACS, FASCRS

  Associate Professor
  Northwell Health, Center for Advanced IBD Care
  Zucker School of Medicine at Hofstra/Northwell Health
  New York, NY, United States

  Disclosure information not submitted.
• TS

  Toyooki Sonoda, MD

  Associate Professor of Surgery
  NYU Langone Long Island Hospitals
  Mineola, New York, United States

  Disclosure information not submitted.
• 

  Alton G. Sutter, MD, PhD

  Assistant Professor of Surgery
  Wake Forest University School of Medicine
  Wake Forest
  Winston-Salem, NC, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• DW

  Daniel Wong, MD MHS

  Assistant Professor
  Beth Israel Deaconess Medical Center, Harvard Medical School
  Boston, Massachusetts, United States

  Disclosure information not submitted.
• AA

  Ashwin Ananthakrishnan, MD, MPH

  Associate Professor
  Massachusetts General Hospital
  Boston, Massachusetts, United States

  Disclosure information not submitted.
• CB

  Cecilia Birisan, MD

  Colorectal Surgeon
  Northwell Health
  Woodbury, New York, United States

  Disclosure information not submitted.
• MB

  Meenakshi Bewtra, MD, PhD, MPH

  Associate Professor of Medicine and Epidemiology
  University of Pennsylvania
  Philadelphia, Pennsylvania, United States

  Disclosure information not submitted.
• KC

  Kristen Crowell, MD

  Assistant Professor
  Beth Israel Deaconess Medical Center, Harvard Medical School
  Harvard Medical School
  Boston, MA, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• CH

  Christina Ha, MD

  Associate Professor
  Mayo Clinic Arizona
  Scottsdale, Arizona, United States

  Disclosure information not submitted.
• 

  Sergey Khaitov, MD

  Associate Professor of Surgery
  Icahn School of Medicine
  New York, New York, United States

  Disclosure information not submitted.
• 

  Michael F. McGee, MD (he/him/his)

  Chief, Division of Colorectal Surgery
  University of Michigan
  University of Michigan
  Ann Arbor, MI, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no relevant relationships with ineligible companies.
• AO

  Asya Ofshteyn, MD, MPH

  Colon and Rectal Surgeon
  Private Practice - San Jose Colorectal
  San Jose, California, United States

  Disclosure information not submitted.
• 

  Ian M. Paquette, MD

  Professor of Surgery, Chief of Colon and Rectal Surgery
  University of Cincinnati College of Medicine
  Cincinnati, OH, US

  Disclosure information not submitted.
• DR

  Daniel Rossi, DO, FACS, FASCRS

  Partner
  Providence Alaska, Alaska Regional Hospitals
  Anchorage, Alaska, United States

  Disclosure information not submitted.
• ET

  Erin Teeple, MD

  Pediatric Surgeon, Colorectal Surgeon
  Locums
  Washington, District of Columbia, United States

  Disclosure information not submitted.

Purpose/Background: Ileal pouch-anal anastomosis (IPAA) is a complex restorative procedure performed for patients with ulcerative colitis, familial adenomatous polyposis, and select cases of Crohn's colitis. In 2016, the American Society of Colon and Rectal Surgeons (ASCRS) published the Rectal Cancer Checklist, representing the initial step towards the National Accreditation Program for Rectal Cancer (NAPRC). Currently, there is no standardized synoptic operative report for IPAA. We aimed to develop consensus on essential operative elements for standardized IPAA reporting.

Methods/Interventions: We conducted a modified Delphi consensus process using a structured list of candidate items derived from literature review and expert input. A total of 73 participants from 54 institutions in 6 countries were invited, including 49 colorectal surgeons (all active members of the ASCRS 2024 IBD Committee) and 22 IBD-gastroenterologists experienced in caring for pouch patients. Participants completed two online survey rounds using REDCap. In Round 1, all 59 candidate items across four domains (patient characteristics, proctectomy, pouch construction, and ancillary maneuvers) were rated on a 9-point Likert scale of importance. Items rated 7-9 by ≥80% of respondents were considered to have achieved consensus and were excluded from re-rating in Round 2. Items without consensus were carried forward to Round 2. Descriptive statistics including percent agreement were calculated in JMP v19.

Results/Outcomes: Thirty-two participants (response rate, 45%) completed Round 1, and 22 of these (69%) completed Round 2. Round 1 respondent demographics reflected broad geographic distribution from 26 institutions across 3 countries, and 16 U.S. states, represented. The most highly represented regions were the Northeast (34%) and Midwest (28%). Most respondents were male (68%), colorectal surgeons (78%, including two pediatric surgeons) and 7 (22%) were IBD gastroenterologists. Most respondents (84%) were younger than 54 years of age. A total of 64% of the surgeons perform >5 IPAAs annually. Of the initial 59 items, 14 (25%) reached consensus after Round 1, e.g., diagnosis, indication for colectomy, personal history of perianal disease, pouch shape, distance from staples to dentate line (in cm), and use of a diverting loop ileostomy. Of the 45 items re-rated in Round 2, 3 (7%) additional items reached consensus including personal history of dysplasia or cancer, primary sclerosing cholangitis, or perianal disease or surgery-yielding 16 total consensus items. Four additional provisional items (personal history of ileitis, mesorectal plane, straight mesentery, diverting loop ileostomy distance from pouch in cm) went up from Round 1 to Round 2, and a fifth provisional item (prior radiotherapy) was suggested in Round 2. After collapsing five related items into a single category ("personal history"), a total of 18 consensus or provisional items were then used to populate a synoptic template (Figure 1).

Conclusion/Discussion: Through a structured modified Delphi process, the IPAA-SONAR study identified 18 core elements for inclusion in a standardized IPAA synoptic operative report pending further validation. These elements provide a foundation for consistent operative documentation, benchmarking, and will inform the next phase-development of Key Performance Indicators (KPIs) for pouch surgery. Development of this IPAA synoptic operative report may represent the first step on the pathway towards a National Pouch Accreditation Program modeled on the NAPRC.

Figure 1. IPAA-SONAR Synoptic Operative Checklist Template