Ulcerative colitis (UC) is a more severe disease in children than in adults and is less likely to be cured without surgery. Total colectomy and rectal mucosectomy provide a permanent cure for children who have UC. Reconstruction with an endorectal ileal pull-through procedure with ileal reservoir is an excellent alternative to a permanent ileostomy. This operation can be performed with low morbidity and with an approximately 94% expectation of good-to-excellent function based on our clinical experience with 94 children and 273 adults.