The importance of early surgery in children with ulcerative colitis.
BACKGROUND
Ulcerative colitis begins in early childhood in 4% of cases. Medical therapy is non-specific, and as many as 70% of children will ultimately require surgery. The dynamic growth, physical and psychological changes that characterize childhood are severely compromised by the complications of ulcerative colitis and its therapy.


OBJECTIVE
To review the outcome of children undergoing early surgery for ulcerative colitis at a tertiary medical center in Israel.


METHODS
A retrospective review was conducted of all children operated on following failure of medical therapy for ulcerative colitis during a 5 year period.


RESULTS
Eleven children underwent a J-pouch procedure with ileo-anal anastomosis in one to three stages. Postoperative complications included recurrent pouchitis in 5 patients, intestinal obstruction in 3, fistula with incontinence in one, stricture in one, and wound infection in 4. Follow-up revealed that most of the patients have three to four soft bowel movements daily. All currently enjoy normal physical activities and a rich social life.


CONCLUSIONS
The quality of life in children with ulcerative colitis was markedly improved following J-pouch surgery. This procedure was not associated with major complications. We recommend early surgery as an alternative to aggressive medical therapy in children with this disease.
Nagar
H
H
Department of Pediatric Surgery, Tel Aviv Sourasky Medical Center, Israel. Hnagar@post.tau.ac.il
Rabau
M
M
D000293:Adolescent; D002648:Child; D003093:Colitis, Ulcerative / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D016737:Proctocolectomy, Restorative; D011788:Quality of Life; D013997:Time Factors