Surgery for pediatric ulcerative colitis.

Restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA) has become the "gold standard" operation for treatment of ulcerative colitis refractory to medical therapy. The J-pouch is the simplest to construct, produces the fewest complications, and is used most commonly. Long-term function with the IPAA is good in approximately 90% of cases, and patient satisfaction is high. Controversial aspects of the operation include 1) whether mucosectomy and hand-sewn IPAA is better than anal transition zone preservation and stapled anastomosis, 2) whether a temporary diverting ileostomy should be used, 3) the role for IPAA in the treatment of indeterminate colitis, 4) the etiology and the most effective treatment for pouchitis, and 5) the best method for salvaging the failed pelvic pouch.