Despite advances in medical therapy, approximately 70-80% of patients with Crohn’s disease (hereafter referred to as CD) will require surgery during their lifetime. However, surgery does not cure CD, and postoperative recurrence of CD is very common; therefore, in patients with CD, surgery is usually performed to alleviate worsening symptoms or to address acute complications, while preserving bowel function needs to be considered. Surgical treatment of CD of the small bowel and ileocecal type CD is clearly defined as requiring surgical intervention with significant lesion sites and preservation of as many normal bowel segments as possible. The terminal ileum and cecum are the two most susceptible sites, resulting in the need for surgery in approximately 40% of patients. Patients with ileocolic disease have a 75% probability of surgery within 5 years of onset, compared to 90% at 10 years. Ileocecal-type surgery is limited to resection of the ileocecal portion, and studies have confirmed comparable complications and mortality rates for laparoscopic and open surgery. The reoperation rates at 5 and 10 years after the first surgery were 20% and 35%, respectively. Approximately 10-20% of patients have the small bowel type (lesions involving only the jejunum), and the efficacy of conservative medical therapy in these patients is not yet satisfactory. Some patients may progress to fibrotic stenosis, and the choice of small bowel stenoplasty at this time can greatly reduce the probability that the patient will eventually develop short bowel syndrome. This procedure is safe and does not increase the risk of recurrence after surgery. Endoscopic dilatation of colonic or ileocolonic strictures is currently being performed in some foreign medical centers, and this treatment has the potential to delay the time to first surgery in some patients. Continued smoking after surgery can increase the risk of recurrence. Colonic CD Colonic CD accounts for about 20-30% of overall CD. These patients account for about 25% of all patients who have had a colectomy. Several surgical approaches are used in colonic CD, but the extent of resection is a matter of controversy. A recent meta-analysis of 6 published studies comparing segmental and sub-total resections for colonic CD reported a recurrence rate of 25% to 72% for segmental resection and a cumulative 10-year recurrence rate of 66%. In contrast, the 10-year cumulative reoperation rate after total colectomy with ileorectal anastomosis was 37-74%. Most studies report perianal lesions as a risk factor for surgical recurrence. In a patient with only a short segment of bowel involved, segmental resection is advantageous. For that diffuse, distal involvement with concomitant perianal lesions who are at high risk of postoperative recurrence, aggressive total colectomy should be advocated.