Contemporary major abdominal surgical management of Crohn’s disease in the era of biologics and minimally invasive surgery

Surgery for ileocolic and colonic Crohn’s disease (CD) remains challenging. Over the past decade, there have been significant advances in surgical techniques, and the timing of surgery for CD patients has been debated. With advances in biological agents, the rate of surgery has significantly decreased, but early ileocolic resection has been advocated. Recently, there has been significant interest in the role of the mesentery in the pathogenesis of CD, with Kono-S mesenteric exclusion anastomosis and extended mesenteric excision advocated by various groups to minimise CD recurrence. There have also been controversies regarding the utility of ileal pouch anal anastomosis after total proctocolectomy. Compared with open surgery, most CD surgeries are now minimally invasive, with increasing evidence for improving short-term outcomes with conventional laparoscopic techniques. The evidence for robotic-assisted surgery in patients with CD is limited at present.