• Crohn's disease
• inflammatory bowel disease
• surgery

Burrill Crohn et al in 1932 stated that “medical therapy is purely palliative and supportive . . ... but in general the proper approach to complete cure is by surgical resection . . ..”.¹ However, by 1987 Bryan Brooke, a committed and creative inflammatory bowel disease surgeon, recognised that “the surgical stance is now one of reluctance . . . operation is withheld as a last resort when all else has failed to achieve palliation or support”. Thus over half a century the surgical view radically changed from reckless enthusiasm to one of extreme conservatism. However, there has always been a fascination with the idea that early resection of localised ileal disease might result in long lasting remission and avoid unwanted complications that would inevitably lead to surgery.

There is no doubt whatsoever that surgery is indicated for an obstructing ileal stricture that fails to respond to medical or endoscopic therapy, for a right iliac fossa mass with internal or external fistulation, for uncontrolled bleeding, or when there is free perforation. However, in the absence of these complications there would seem to be no reason to recommend ileal resection. Early resection should therefore only be considered if it could be demonstrated that this intervention altered the natural …