title: Paediatric ulcerative colitis surgery: Italian survey.
abstract: OBJECTIVE
  Recent epidemiological studies showed an increase in ulcerative colitis among children, especially in its aggressive form, requiring surgical treatment. Although medical therapeutic strategies are standardized, there is still no consensus regarding indications, timing and kind of surgery. This study aimed to define the surgical management of paediatric ulcerative colitis and describe attitudes to it among paediatric surgeons.
  
  
  METHODS
  This was a retrospective cohort study. All national gastroenterology units were invited to participate. From January 2009 to December 2013, data on paediatric patients diagnosed with ulcerative colitis that required surgery were collected.
  
  
  RESULTS
  Seven units participated in the study. Seventy-one colectomies were performed (77.3% laparoscopically). Main surgical indications were a severe ulcerative colitis attack (33.8%) and no response to medical therapies (56.3%). A three-stage strategy was chosen in 71% of cases. Straight anastomosis was performed in 14% and J-pouch anastomosis in 86% of cases. A reconstructive laparoscopic approach was used in 58% of patients. Ileo-anal anastomosis was performed by the Knight-Griffen technique in 85.4% and by the pull-through technique in 9.1% of patients. Complications after colectomy, after reconstruction and after stoma closure were reported in 12.7, 19.3 and 35% of cases, respectively.
  
  
  CONCLUSIONS
  This study shows that there is general consensus regarding indications for surgery. The ideal surgical technique remains under debate. Laparoscopy is a procedure widely adopted for colectomy but its use in reconstructive surgery remains limited. Longer follow-up must be planned to define the quality of life of these patients.
authors.affiliation: DINOGMI, University of Genova, Genova, Italy Pediatric Surgery Unit, G. Gaslini Children's Hospital-IRCCS, Genova, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Mattioli
authors.affiliation: Pediatric Gastroenterology Unit, G. Gaslini Children's Hospital-IRCCS, Genova, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Barabino
authors.affiliation: Department of Pediatrics, Sapienza University of Rome, Rome, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Aloi
authors.affiliation: Pediatric Gastroenterology Unit, G. Gaslini Children's Hospital-IRCCS, Genova, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Arrigo
authors.affiliation: Surgery and Digestive Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: T
authors.initials: T
authors.lastname: Caldaro
authors.affiliation: DINOGMI, University of Genova, Genova, Italy Pediatric Surgery Unit, G. Gaslini Children's Hospital-IRCCS, Genova, Italy marcellocarlucci@yahoo.it.
authors.forename: M
authors.initials: M
authors.lastname: Carlucci
authors.affiliation: Department of Pediatrics, Sapienza University of Rome, Rome, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Cucchiara
authors.affiliation: Surgery and Digestive Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: P
authors.initials: P
authors.lastname: De Angelis
authors.affiliation: Gastroenterology Unit, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Di Leo
authors.affiliation: Department of Pediatrics, Unit of Pediatric Gastroenterology and Digestive Endoscopy - Ospedale Civile Spirito Santo, Pescara, Italy.
authors.forename: M T
authors.initials: MT
authors.lastname: Illiceto
authors.affiliation: Pediatric Surgery Unit, Department of Pediatric, Gynecological, Microbiological and Biomedical Sciences, University of Messina, Messina, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Impellizzeri
authors.affiliation: DINOGMI, University of Genova, Genova, Italy Pediatric Surgery Unit, G. Gaslini Children's Hospital-IRCCS, Genova, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Leonelli
authors.affiliation: Pediatric Surgery Unit, 'G. d'Annunzio' University of Chieti, Chieti Italy.
authors.forename: G
authors.initials: G
authors.lastname: Lisi
authors.affiliation: Department of Pediatrics, Unit of Pediatric Gastroenterology and Digestive Endoscopy - Ospedale Civile Spirito Santo, Pescara, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Lombardi
authors.affiliation: Gastroenterology Unit, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Martelossi
authors.affiliation: Department of Translational Medical Science, Section of Pediatrics, University of Naples 'Federico II', Naples, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Martinelli
authors.affiliation: Department of Translational Medical Science, Section of Pediatrics, University of Naples 'Federico II', Naples, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Miele
authors.affiliation: IBD Unit Pediatric Department,University of Messina, Messina, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Randazzo
authors.affiliation: IBD Unit Pediatric Department,University of Messina, Messina, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Romano
authors.affiliation: Pediatric Surgery Unit, Department of Pediatric, Gynecological, Microbiological and Biomedical Sciences, University of Messina, Messina, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Romeo
authors.affiliation: Surgery and Digestive Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Romeo
authors.affiliation: Unit of General Surgery, University of Naples 'Fedrico II', Naples, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Selvaggi
authors.affiliation: IBD Unit Pediatric Department,University of Messina, Messina, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Valenti
authors.affiliation: Surgery and Digestive Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Dall'Oglio
mesh_terms: D000293:Adolescent; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000601:surgery*; D003125:Colostomy / Q000009:adverse effects; D003672:Defecation; D004351:Drug Resistance; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D005762:Gastroenterology; D006801:Humans; D007558:Italy; D008297:Male; D019449:Pouchitis / Q000209:etiology; D016737:Proctocolectomy, Restorative / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: IBD; Paediatric ulcerative colitis; surgery