New aspects of surgical therapy of recurrent Crohn's disease

Crohn's disease can neither be cured by surgery nor by medical therapy. Sur gical therapy of recurrent Crohn's disease requires special precautions. Th e recurrence rate is 60% after 15 years. There are no certain data of the r isk factors influencing the recurrence rate. The only clear facts are that wide resection out of the resection margins and smoking negatively influenc e recurrence. Hence, the major principle of therapy is a minimally-resected surgery. This mainly concerns strictures and stenosis. Strictures should b e treated by stricturoplasty and stenosis by limited resection with Crohn-f ree resection margins. Just in case of interenteric and enterocutanous with a concomittant short bowel syndrome, in blind-ending fistulas with an absc ess or in enterovesical fistulas, we recommend immediate operation. The the rapy of recurrent anorectal Crohn's disease underlies the same rules as pri mary therapy. If necessary, proctectomy remains the last option. Also, emer gency surgery in recurrent Crohn's disease follows the same rules as in ele ctive surgery.