[Surgical treatment of Crohn disease of the small intestine].

Crohn's disease is potentially panintestinal and early, wide resections do not always prevent recurrences. The current approach is to intervene when indicated by the clinical situation and to perform small intestine-saving procedures. Resections remove involved zones and a limited margin of healthy tissue. Laparoscopic procedures have been developed, particularly for ileocaecal resection. These resections are followed by a high recurrence rate, mainly anastomotic, requiring reoperations. No technical factor appears to be involved in the appearance of these recurrences and their prevention is based on medical treatment of limited efficacy. At best augmentation plasties of stenoses save the length of the small intestine. They are particularly indicated in the case of stenoses at various levels of the small intestine. They are performed safely and effectively. However, the recurrence and reoperation rates are at least equal to those of resections. The indications for surgery are primarily emergencies: intestinal perforation, obstruction, haemorrhage. Sepsis of the peritoneal cavity may justify deferred restoration of intestinal continuity, with creation of a stoma. Forms complicated by an abscess may benefit from elective drainage followed by secondary resection. In the case of fistulas, it is important to spare the "target" structure, intestine or bladder, as far as possible in order to limit the extent of resection. In poorly tolerated chronic forms, refractory to medical treatment, the decision to operate must not be delayed. Surgery generally provides improvement of the patient's condition and the consequences of intestinal resection are less serious than those of the spontaneous course of lesions which are left untreated for too long.