Introduction

Crohn's disease is a complex disease with a complicated natural history that differs greatly from the majority of common diseases of the gut. It is a panen-teric, incurable disease. It has a peak incidence in young people and onset in childhood is not uncommon. The majority of patients will need surgery within 10 years from diagnosis and 50% of them will undergo additional operations for recurrent disease, with 8-10% of patients recurring every year. Many patients will undergo surgery after long periods of steroid or immunosuppressive treatment and therefore their immunological status is poor. In addition, these individuals have a high risk of receiving a stoma, either permanent or temporary (41 and 14% respectively) [1].

For all these reasons, the laparoscopic approach, which has the theoretical advantage of preserving the abdominal wall, reducing intra-abdominal manipulation and thus adhesion formation and helping to reduce immunological stress, when compared to the open surgery, could be the approach of choice for the treatment of such patients.

The comparison of laparoscopy and an open approach for the surgical treatment of Crohn's disease is difficult to make, due to the difficulty of stratifying patients in homogenous groups, in particular those with complicated disease. The only randomised trial available so far is elective ileocolic resectioning for refractory non-complicated disease of the terminal ileum [2]. Studies on laparoscopic treatment of complicated disease so far have been cohort, or case series studies. This understandably categorises them as grade 3-4 evidence and therefore rate low in terms of recommendation (Table 1). The results and the recommendations about the use of laparoscopy for the treatment of Crohn's disease vary according to the type and the severity of the disease, and therefore must be described separately in brief.

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