Abstract
Historically up to 80% of Crohn’s disease patients required at least one surgical resection in their lifetime. Current ‘treat to target’ management and a burgeoning availability and variety of agents beyond anti-tumour necrosis factor alpha drugs aim to delay and/or reduce the rates of surgery in Crohn’s disease. However, surgery continues to be necessary for many. Even more difficult for patients is the need for repeated surgery with the impact this has on their daily life as well as the increasing risk of stoma and nutritional deficiencies with each operation. Despite the use of biologics, immunomodulators and antibiotics post-operative recurrence is common leading to re-operation in about a third of patients at 10 years from the first operation. Therefore, new approaches are required. Predicting which patients will develop recurrence using genetic and microbiome markers is one approach. Choosing surgical techniques that reduce recurrence rates is another and finally dietary approaches to manipulate the microbiome to reduce recurrence are another potential avenue. We review the literature on postoperative recurrence rates as well as the evidence for these alternative approaches. The aim is to be able to reduce recurrence rates whilst accurately predicting which patients will have disease recurrence with the ultimate goal of a more personalised preventive approach.