Surgical treatment of ulcerative colitis

Ulcerative colitis is primarily a disease of the rectal and colonic mucosa. The disease begins in 4% of patients before the age of 10, and in 18% between the ages of 10 and 20. The disease is more severe in children than in adults and is often associated with more overt symptoms. Ulcerative colitis can be cured by surgically removing the diseased colon and rectum. The aims of surgical treatment are: to remove the diseased bowel and to return the patient to health; to preserve the anus for defecation; to maintain continence; to obviate the need for a permanent ileostomy; and to lessen the risk of complications. The surgical options proposed for children affected by ulcerative colitis include endorectal mucosectomy followed by an ileo-anal anastomosis with (ileal pouch–anal anastomosis [IPAA]) or without (endorectal pull-through [ERPT]) creation of a pouch. If ERPT represents a good choice for treating severe ulcerative colitis in paediatric patients, IPAA seems to show better results. Both these procedures are illustrated, with an analysis of related advantages and complications, considering also an evaluation of the quality of life of patients who have undergone this kind of surgery.