Ileocaecal Crohn's-When Should the Surgeon Intervene?

Huge advances in the medical treatment of ileocaecal Crohn's disease have occurred in the last 20 years. Consequently, surgery has become synonymous with treatment failure and is often only implemented when multiple medical interventions have been trialled. However, evidence that patients avoid surgery in the long term is questionable. When surgery occurs, the disease progresses. Surgery is more complex and outcomes such as complications and stoma formation are more common. Many studies suggest that, in terms of longer-term quality of life, earlier surgery may be superior. Specific clinical scenarios exist where this benefit is more obvious (fibrostenotic or fistulating disease) but even with disease limited to the lumen, benefits can be realised. Significant barriers exist to this mindset of earlier surgery. Such barriers can only be overcome with a vigorous multidisciplinary approach. This editorial describes the debate surrounding the concept of early bowel resection in these patients.