Surgical treatment of Crohn's disease

Chronic history of Crohn's disease (CD) with frequent relapses leads to maj or discomfort. Difficult medical control and occurrence of evolutive compli cations may require surgery. Most of the patients have to be operated on du ring CD. Surgical treatment is advised only when complications occur (steno sis, abces, or even no effect of medical treatment). Surgical resections ha ve to be short, in order to preserve the longest intestinal segment. Their limits have to be situated in macroscopic normal tissues, with no need of l ong margins of macroscopically normal intestin. Anoperineal lesions are a d ifficult therapeutical challenge. Surgery is performed only when lesions ar e symptomatic and infected (fistulae, abcesses). Main problem in CD remains the high frequency of relapse. Numerous predictive factors have been obser ved. The only parameters which showed to be effective in preventing relapse s are : the necessity to perfom the resection in an intestinal macrosopical ly normal zone, without lesion of CD, and the medical treatment of CD. Comf ort evaluation in patients shows that the association of medical and surgic al procedures leads to an acceptable functionnal status, even if no curativ e treatment exists at the moment.