**3. Crohn disease**

### **3.1 Surgical options**

#### *3.1.1 Resection*

The primary approach is to resect the small bowel stricture. Resection is associated to lower rates of recurrence. Patients submitted do strictureplasty alone may present a higher rate of disease recurrence [24]. The patient should have a small length stricture and no prior resection (**Table 4**).

Surgery may be done by laparotomy or laparoscopy with same good results and 2 cm margins of normal tissue is advised to make an anastomosis. Both anastomosis may be used: hand-sewn or stapled.

When a ileocolic resection is done the mesentery should be removed. When mesentery is left it is associated with higher recurrence rates and reoperations [25].

#### *3.1.2 Bypass*

Bypass surgery has been rarely employed due to the risk of neoplasia in the excluded segment [26, 27]. It may be an option to treat duodenal disease. There are two types of bypass: simples bypass and exclusion bypass [28]. Exclusion bypass

Crohn's disease is a panintestinal disease, with intermittent activity and the potential of focal exacerbations throughout the patient's life

It is impossible to cure Crohn's disease by excision. The surgeon is required only to treat the complications

The essence of surgical treatment is to make the operation as safeas possible. If the operation becomes safe and patients survive, they will inevitably have recurrences and so repeated operations may be required.

Therefore, it is important to conserve as much gut as possible All diseased bowels need not be excised, only that part with complications

If only stenotic complications are being treated, perhaps the stenosis can be simply widened by strictureplasty or dilatation

#### **Table 4.**

*Five "Golden Rules" of surgical management of Crohn's disease.*

*Current Elective Surgical Treatment of Inflammatory Bowel Disease DOI: http://dx.doi.org/10.5772/intechopen.100112*

is used when you cannot remove the affected segment because adherences to the retroperitoneum (**Figure 7**).
