ABSTRACT
Large bowel Crohn’s disease (CD) was first described in 1960 by Lockhart and Morson. A laparoscopic approach is considered as the best approach in CD patients for segmental colonic resection, total colectomy with ileorectal anastomosis (IRA) or total proctocolectomy ileal pouch-anal anastomosis (IPAA). The main principle for surgical treatment of large bowel CD is to delay the occurrence of a definitive end stoma. The laparoscopic approach was also proven to be beneficial for the patient for secondary proctectomy and IPAA, with significant reduction in cumulative hospital stay and cumulative post-operative severe morbidity compared to the open approach. In patients with extensive Crohn’s colitis refractory to medical therapy, symptomatic stenosis, selected cases of associated colonic dysplasia or cancer, a total colectomy with IRA is the operation of choice. IRA can be performed in one step during elective surgery for refractory CD or, more frequently, in two steps after a first step of subtotal colectomy for acute colitis.
