Conclusions

From the data currently available, firm and absolute recommendations cannot be drawn for the use of laparoscopy in the surgical treatment of Crohn's disease, due to the heterogeneous features of the disease.

For elective ileocolic resections, laparoscopy offers better immediate post-operative results possibly at a lower global cost and with potentially less incidence of small-bowel obstructions due to adhesions in the long-term. For complex disease, laparoscopy can be offered as a trial to all patients. Inflammatory masses, presence of fistulas and reoperation for recurrence are not absolute contraindications for this approach, even though they are the most significant cause of conversion. Pre-operative percutaneous drainage of abscesses together with accurate pre-operative medical therapy can be used to render surgery less demanding. For isolated perianal Crohn's disease, laparoscopy can be considered the approach of choice for stoma construction.

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