Aim Low anterior resection syndrome (LARS) is pragmatically defined as disordered bowel function after rectal resection leading to a detriment in quality of life. This broad characterization does not allow for precise estimates of prevalence. The LARS score was designed as a simple tool for clinical evaluation of LARS. Although the LARS score has good clinical utility, it may not capture all important aspects that patients may experience. The aim of this collaboration was to develop an international consensus definition of LARS that encompasses all aspects of the condition and is informed by all stakeholders. Method This international patient–provider initiative used an online Delphi survey, regional patient consultation meetings, and an international consensus meeting. Three expert groups participated: patients, surgeons and other health professionals from five regions (Australasia, Denmark, Spain, Great Britain and Ireland, and North America) and in three languages (English, Spanish, and Danish). The primary outcome measured was the priorities for the definition of LARS. Results Three hundred twenty‐five participants (156 patients) registered. The response rates for successive rounds of the Delphi survey were 86%, 96% and 99%. Eighteen priorities emerged from the Delphi survey. Patient consultation and consensus meetings refined these priorities to eight symptoms and eight consequences that capture essential aspects of the syndrome. Sampling bias may have been present, in particular, in the patient panel because social media was used extensively in recruitment. There was also dominance of the surgical panel at the final consensus meeting despite attempts to mitigate this. Conclusion This is the first definition of LARS developed with direct input from a large international patient panel. The involvement of patients in all phases has ensured that the definition presented encompasses the vital aspects of the patient experience of LARS. The novel separation of symptoms and consequences may enable greater sensitivity to detect changes in LARS over time and with intervention.

One-fifth of patients reported fecal urgency, fecal incontinence, or incomplete emptying after surgery for diverticulitis. Despite the limitations of our study, these results are concerning and should be investigated further prospectively.

Background: Functional outcomes following J-pouch for ulcerative colitis have been studied, but lack standardization in which symptoms are reported. Furthermore, the selection of symptoms studied has not been patient-centered.Objective: Utilize a validated bowel function survey to determine which symptoms are present after J-pouch, and whether patients display a functional profile similar to Low Anterior Resection Syndrome. Design: Retrospective analysis of a prospectively maintained single center database Settings: Colorectal surgery center of a tertiary care academic hospital Patients: 159 J-pouch patients, ≥6 months after ileostomy reversal Main Outcome Measures: Memorial Sloan Kettering Cancer Center Bowel Function Instrument; original Bowel Function Instrument validation cohort used as historical comparison (n=127) Results:The mean total Bowel Function Instrument score for the J-pouch cohort was 59.9+/−9.7 compared to a reported average score of 63.7+/−11.6 for low anterior resection patients in the validation cohort (p<0.001), indicating worse bowel function in J-pouch patients. When evaluating the Bowel Function Instrument subscales, J-pouch patients reported frequency subscale scores of 18.2+/−3.8, diet scores of 12.2+/−3.8, and urgency scores of 15.9+/−3.7, compared to 21.7+/−4.5

Purpose: Many surgeons assume 3-stage ileal pouch-anal anastomosis (IPAA) is safer than 2stage IPAA in patients with active ulcerative colitis (UC), although recent data suggest outcomes are comparable. This study aimed to compare perioperative complications, late complications, and functional outcomes after 2-versus 3-stage IPAA in patients with active UC. Methods: A retrospective review was conducted of patients who underwent 2-or 3-stage IPAA for active UC from 2000-2015 in a high-volume institution. Patients completed quality of life surveys six months following ileostomy reversal. Perioperative and late complications were recorded. Outcomes were compared with the Fisher Exact test, and multivariable logistic regression was used to adjust for potential confounders. Results: We identified 212 patients who underwent 2-or 3-stage IPAA for active UC, of whom 157 patients (74.1%) underwent 2-stage procedures and 55 (25.9%) underwent 3-stage procedures. More patients undergoing 2-stage procedures were taking immunomodulators preoperatively (46.3% vs. 23.1%, p=0.01), but there was no difference in use of steroids (p=0.09) or biologic agents (p=0.85). Three-stage procedures were more likely to be urgent (78.6% vs. 30.2%,