The importance of early surgery in children with ulcerative colitis

Background: Ulcerative colitis begins in early childhood in 4% of cases. Me dical therapy is non-specific, and as many as 70% of children will ultimate ly require surgery. The dynamic growth, physical and psychological changes that characterize childhood are severely compromised by the complications o f ulcerative colitis and its therapy. Objective: To review the outcome of children undergoing early surgery for u lcerative colitis at a tertiary medical center in Israel. Methods: A retrospective review was conducted of all children operated on f ollowing failure of medical therapy for ulcerative colitis during a 5 year period. Results: Eleven children underwent a J-pouch procedure with ileo-anal anast omosis in one to three stages. Postoperative complications included recurre nt pouchitis in 5 patients, intestinal obstruction in 3, fistula with incon tinence in one, stricture in one, and wound infection in 4. Follow-up revea led 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 ma rkedly improved following J-pouch surgery. This procedure was not associate d with major complications. We recommend early surgery as an alternative to aggressive medical therapy in children with this disease.