Abstract
Recurrence after surgically induced remission in Crohn's disease remains a topic of
research and debate with significant clinical implications for overall quality of
life and intestinal and defecatory functions. While the surgeon continues to play
a critical role in surgical prophylaxis of recurrence, optimal results will only be
obtained in the setting of a true multidisciplinary team approach, following the principles
of “the right surgery, on the right patient, at the right time, performed by the right
surgeon, supported by the right team.” The centerpiece of surgical prophylaxis is
the intestinal anastomosis. The ideal anastomosis after resection for Crohn's disease
should be safe and reliable, as postoperative septic complications have been shown
to increase the risk of recurrence; result in a wide lumen and a configuration that
would not impede enteric flow; exclude or excise the mesentery, a known culprit in
primary and recurrent disease; and preserve vascularization and innervation. This
article will review the evidence supporting the above-mentioned surgical principles
and the long-term results of the different anastomotic configurations.
Keywords
Crohn's disease - anastomotic techniques - mesentery - microbiome - surgical recurrence
