Crohn's disease: is minimally invasive surgery the gold standard? A narrative review

Background and Objective: Minimally invasive surgery (MIS) is associated with reduced postoperative pain, shorter hospital stay, faster return to normal activity and diet, and improved cosmesis when compared to conventional open surgery. After the first laparoscopic ileocecal resections described in 1993, colorectal surgeons around the world started using multiport laparoscopic, single-port laparoscopic, and even robotic approaches for the surgical treatment of Crohn's disease (CD), from simple uncomplicated cases to more challenging forms of penetrating and recurrent disease, in order to achieve the mildest surgical stress and the best postoperative functional recovery. This narrative review aims to provide a comprehensive description of the forms of MIS currently used for the surgical treatment of CD. Methods: We searched original papers and reviews, published by November 2022, about the applications of MIS in the operative management of CD using PubMed. Relevant studies were identified using different combinations of the following search terms: "Crohn's disease", "fistulizing Crohn's disease", "penetrating Crohn's disease", "recurrent Crohn's disease", "Crohn's colitis", "ileocecal resection", "laparoscopy", "laparoscopic surgery", "robotic surgery", "minimally invasive surgery", and "ERAS". Key Content and Findings: We describe a variety of minimally invasive surgical approaches for the treatment of CD, from laparoscopic ileocecal resection for uncomplicated and complicated diseases, to laparoscopic colectomies and robotic-assisted procedures, focusing on the advantages of each technique in terms of short-and long-term outcomes. Conclusions: It is unquestionable that MIS has demonstrated improved peri-operative results in the surgical management of CD, thus representing the current "gold standard" approach even in this patients' category, when appropriate expertise is available.