From resection to preservation: redefining the surgical paradigm in Crohn’s disease

Surgery is a pivotal component of the management of Crohn's disease (CD), particularly in cases of disease-related complications or failure of medical therapy. However, the risk of short bowel syndrome following multiple large resections makes bowel preservation strategies a major therapeutic priority. This review gathers insights from a diverse group of inflammatory bowel disease specialists, exploring the full spectrum of bowel-preserving strategies, from conservative surgical techniques and peri-operative optimization to emerging innovations in robotic surgery. The therapeutic paradigm of treat-to-target and tight disease monitoring is shifting the focus from reactive interventions to proactive and personalized care. Looking ahead, the evolving implementation of multi-omics profiling and artificial intelligence holds promise to reshape the role of surgery in CD. Surgery should no longer be viewed solely as a response to complications, but rather as an individualized, biology-driven strategy that prioritizes bowel preservation. In this rapidly advancing field, innovation is measured not only by clinical outcomes but also by every centimeter of bowel preserved.