Drug therapy is ineffective 1. Surgery should be considered for patients with poor response to drug therapy, complications, or poor compliance. 2. For patients who are receiving anti-TNF drugs, high-dose glucocorticoids, and/or cyclosporine therapy, staged surgery is recommended, considering the risk of postoperative complications. However, individualized decisions should be made based on the patient’s risk stratification, overall clinical status, and the physician’s judgment. Inflammation Patients with acute colitis who present with signs or symptoms of impending or established perforation should usually be treated surgically. Strictures 1. Endoscopic dilation is indicated for patients with small bowel or anastomotic strictures that have failed to respond to symptomatic pharmacologic therapy. 2. Surgical treatment is indicated for patients with symptomatic small bowel or anastomotic strictures for whom drug and endoscopic treatment has failed. 3. Surgical resection should be considered in patients with colonic strictures that cannot be adequately visualized endoscopically. Perforated disease 1. Patients with spontaneous perforation need to be treated surgically. 2. Patients with intestinal wall abscess, inter-intestinal abscess, intra-intestinal abscess or retroperitoneal abscess can be treated with antibiotics, with or without percutaneous perforation drainage. In case of treatment failure, surgical drainage with or without resection of intestinal segments should be considered. 3. Surgical treatment should be considered for patients with combined intestinal fistulas or those who have been treated with medications but still have local or systemic signs or symptoms of sepsis. Bleeding Patients with obvious gastrointestinal bleeding and stable disease should undergo endoscopic examination and treatment and/or interventional treatment. Patients with unstable disease should undergo surgical exploration. Growth retardation Prepubertal patients with significant growth retardation and ineffective drug therapy should be considered for surgical treatment. Tumor formation 1. Patients with long-term ileocolic or colonic type of CD should undergo colonoscopic surveillance. 2. Total colorectal resection may be considered for patients with CD who have malignancy in the colorectum, lesions or masses associated with non-adenomatous atypical hyperplasia, highly atypical hyperplasia, and multifocal low-grade atypical hyperplasia. 3. Suspected lesions (e.g., masses, ulcers) in patients with CD require tissue biopsy, especially in patients who are considered for small bowel strictureplasty. Technical considerations 1. For patients with involved bowel segments requiring resection, laparoscopic surgery should be performed if experience and technology allow. 2. If a one-stage anastomosis is feasible after resection of the diseased bowel segment, the surgeon should decide the most appropriate anastomosis. Surgery for specific lesions 1. terminal ileum, ileocolon, upper gastrointestinal tract 2. For patients with lesions in the jejunum, proximal ileum, terminal ileum, or ileocolon requiring surgery, if short bowel syndrome does not occur or is not imminent, resection of the diseased bowel segment should generally be performed. 3.Some screened patients with gastroduodenal symptoms may be considered for endoscopic dilatation, bypass or stenoplasty of the lesion. Colon 1. Transabdominal colectomy and terminal ileostomy are preferred for emergency CD surgery. 2, Patients with rectal lesions not involved in the rectum requiring elective surgery may undergo segmental colectomy if they occur in a single bowel segment; while total colectomy should be used for widely spread disease. 3.Patients with rectal lesions requiring surgery mainly undergo total colectomy or proctocolectomy with stoma. 4, Total colorectal resection plus IPAA is usually not recommended for patients diagnosed with CD.