The changing landscape of surgery for Crohn's disease

The incidence of Crohn's disease is increasing world-wide and the disease location and behavior is changing towards more colonic as well as inflammatory behavior. As previous data have spoken towards ileal disease and structuring and penetrating disease to be the indications most in need of surgery, one could expect the surgical load to decrease. As these changes are relative, the absolute numbers of surgical interventions are less affected. There are also data showing an increasing complexity among patients at time of surgery. Finally, a new role for surgery as initial therapy to induce remission instead of biologic therapy in ileal or ileocaecal disease has been suggested. In order to improve the care for patients with Crohn's disease in general, and the peri‑operative phase in particular, the use of multidisciplinary team discussions is essential. In conclusion, the role of surgery is changing. Fewer patients need surgery, but when they do they have more complex disease. In the future, ileocaecal resection may be used increasingly as initial therapy to induce remission in a true top-down approach.