How can the surgeon reduce recurrence after surgery for ileocolic Crohn's disease?

Disease recurrence after surgery for ileocolic Crohn's is common, and repeat surgery is necessary for approximately one-third of patients within ten years. This recurrence rate is influenced by many factors, some of which relate to the disease phenotype. Others may be influenced by the patient (i.e., smoking) or the gastroenterologist with careful disease monitoring and the judicious use of adjuvant medication. The surgeon may also be able to reduce recurrence in the both preoperative preparation of the patient, the timing of surgery, and the intra-operative surgical technique. Evidence of how the surgeon can influence recurrence is discussed in this manuscript, considering current definitions, pathophysiology, and risk factors for recurrence.