Surgery for intestinal Crohn's disease has been in constant evolution over the past four decades. The field has been changing due to a better understanding of the pathophysiology and the natural history of the disease and the dramatic advances in medical therapy. In order to understand the rationale behind the different anastomotic techniques and the indications for a resection versus a strictureplasty, we describe the essential steps of the surgical decision making process when approaching a patient with intestinal Crohn's disease, including the surgical indications, pre-operative patient optimization, the choice of different surgical techniques for resection and strictureplasty and the long term results. In this manuscript we summarize our personal opinion based on a thorough review of the literature and extensive personal experience.
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