Key updates in Crohn's disease surgery for the gastroenterologist in 2025

Purpose of review The field of inflammatory bowel disease (IBD) has been evolving at an unprecedented rate. Not only does this apply to the medical management of IBD but also to its surgical management. This review aims to highlight the major updates in the current surgical approach in Crohn's disease. Recent findings Surgery for Crohn's disease is no longer considered only for medically refractory disease or for disease-related complications but can rather be considered as an effective first-line treatment option. The concept of multimodal prehabilitation is becoming more solidified in Crohn's disease, as strong evidence continues to indicate its positive impact on surgical outcomes. The impact of the mesentery as well as the type of surgical anastomosis on postsurgical Crohn's disease recurrence is being closely reexamined. The optimal approach for surgical management of perianal Crohn's disease is also being redefined. Summary Surgery is an integral part of the care of Crohn's disease patients and keeping up with the evolving paradigm of surgery in Crohn's disease is critical for all providers taking care of Crohn's disease patients to ensure patients are getting the best care possible.