Few reports of surgery in children under 14 years of age have been made in ulcerative colitis (UC). Pediatric patients present special problems, such as, adverse influence on school life, indications from surgical treatment, and growth retardation. We studied how many pediatric patients with UC who underwent total proctocolectomy and hand-sewn ileo-anal anastomosis (IAA) at our hospital from 1987 to 2004. Indications for surgery were severe colitis in four, intractability in three, and massive bleeding in one. Emergency surgery was done in 5 patients. The mean preoperative dose of total corticosteroids was about 9,855mg as a dose equivalent to prednisolone. The only early postoperative complication was wound infection in 3 patients, while late postoperative complications, involved small bowel obstruction in two patients, and severe pouchitis, stenosis of the ileostomy, and anastomotic stenosis in one each. No severe complications were encountered. In long-term results, bowel function was satisfactory, no growth retardation was seen, and school life and employment were not interrupted. In conclusion, surgical treatment for pediatric UC patients provided good results.