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This study is a retrospective review of all pediatric patients with ulcerative colitis who underwent colectomy and ileal pouch-anal anastomosis (IPAA) between 1982 and 1992 at the Cleveland Clinic Foundation. The purpose of the review was to determine the effectiveness of IPAA in treating children with ulcerative colitis. Demographic, preoperative, and surgical data were abstracted from archival research of medical records. Quality-of-life information was obtained from patient or parent interviews. Ninety-one children were identified during the study period with a median age of 14.2 years. The principal indication for colectomy was intractable symptoms despite vigorous medical therapy. J-pouches (n = 51) and S-pouches (n = 38) were most commonly constructed. Median follow-up was 1.9 years after ileostomy closure. Thirty early complications (occurring within 30 days of pouch construction) were documented in 21 patients, and 57 late complications (occurring after 30 days) were documented in 34 patients. Small bowel obstruction was the most common early postoperative complication and accounted for 13 of 30 early complications; reoperation was required in four of nine patients. Pouchitis was the most frequent late complication (15 episodes in 12 patients), followed by perineal infection (14 episodes in eight patients), and anastomotic stricture (10 episodes in nine patients). Pouch type, age at colectomy, and disease interval from colectomy to pouch construction were analyzed with relation to the frequency of pouchitis, anastomotic stricture, sepsis, and incontinence. An S-pouch had been used in eight of nine patients with an anastomotic stricture (p = 0.004). The disease interval and age at initial surgery had no bearing on the presence of late complications. The pouches of four female patients were excised as a result of pelvic infection and were subsequently converted to continent ileostomies. Quality-of-life information was obtained for 78 patients. Daytime continence was complete in 67 (86%) children and nocturnal continence was complete in 56 (72%) patients. Seventy-three (94%) patients were very satisfied with their quality of life after IPAA. We conclude that IPAA is an effective surgical procedure for children with ulcerative colitis and results in a relatively normal pattern of defecation with a good long-term functional outcome. Early postoperative complications are common, but only a few patients require further hospitalization or surgery. The most common late complication is pouchitis, which responds to medical treatment. Continence is preserved in the majority of the children, and overall satisfaction with the operation is high.