Surgical interventions in inflammatory bowel disease: Indications, techniques, outcomes, and future directions

doi:10.4292/wjgpt.v17.i2.118778

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 17, Issue 2

This Article

(0) (0) (0) (27)

Peer-Review Report of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Journal Information of This Article

Publication Name

World Journal of Gastrointestinal Pharmacology and Therapeutics

ISSN

2150-5349

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Systematic Reviews

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastrointest Pharmacol Ther. Jun 5, 2026; 17(2): 118778
Published online Jun 5, 2026. doi: 10.4292/wjgpt.v17.i2.118778

Surgical interventions in inflammatory bowel disease: Indications, techniques, outcomes, and future directions

Himanshu Agrawal, Nikhil Gupta

Himanshu Agrawal, Department of Surgery, University College of Medical Sciences (University of Delhi), GTB Hospital, Delhi 110095, India

Nikhil Gupta, Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, Delhi 110001, India

Co-first authors: Himanshu Agrawal and Nikhil Gupta.

Author contributions: Agrawal H conceived and designed the study, performed the literature search, interpreted the data, and drafted the manuscript. He was responsible for critical revision of the article for important intellectual content and approved the final version for submission; Gupta N contributed to literature review, data interpretation, and critical revision of the manuscript for intellectual and clinical relevance. He reviewed and approved the final version of the manuscript. All authors have read and approved the final manuscript and agree to be accountable for all aspects of the work. Agrawal H and Gupta N contributed equally to this work as co-first authors.

AI contribution statement: The authors used ChatGPT (OpenAI) for language refinement and editing without altering the manuscript's scientific content, interpretation, or conclusions. All scientific content and interpretation were developed and verified by the authors.

Conflict-of-interest statement: The authors declare that there are no conflicts of interest related to this manuscript.

PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.

Corresponding author: Nikhil Gupta, Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, BKS Marg, Delhi 110001, India. nikhil_ms26@yahoo.co.in

Received: January 12, 2026
Revised: February 2, 2026
Accepted: February 12, 2026
Published online: June 5, 2026
Processing time: 137 Days and 1.2 Hours

Abstract

BACKGROUND

Inflammatory bowel disease (IBD), encompassing ulcerative colitis (UC) and Crohn’s disease (CD), is a chronic relapsing condition in which surgical intervention remains a cornerstone of management despite advances in medical therapy. Surgery plays a definitive role in UC and a complication-directed, bowel-preserving role in CD.

AIM

To provide a comprehensive narrative overview of contemporary surgical management in IBD, focusing on indications, operative strategies, perioperative optimization, postoperative outcomes, and future directions.

METHODS

A narrative review was conducted following the principles of the PRISMA 2009 guidelines. A comprehensive literature search of PubMed/MEDLINE, EMBASE, Scopus, and the Cochrane Library was performed for studies published between January 2000 and December 2024. Relevant original studies, systematic reviews, and meta-analyses addressing surgical interventions in adult IBD patients were included. Evidence was synthesized descriptively.

RESULTS

Surgical indications in UC include medically refractory disease, dysplasia or malignancy, and life-threatening complications, with restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) representing the standard elective procedure. In CD, surgery is primarily indicated for fibrostenotic and penetrating complications, with emphasis on bowel-sparing approaches such as limited resection and strictureplasty. Minimally invasive and robotic techniques have demonstrated favorable short-term outcomes without compromising long-term results. Perioperative optimization-including nutritional support, steroid minimization, and appropriate integration of biologic therapy-plays a critical role in reducing complications. Postoperative recurrence in CD and pouch-related disorders following IPAA remain major challenges, requiring structured surveillance and multidisciplinary care.

CONCLUSION

Surgery continues to play a vital and evolving role in the management of IBD. Advances in surgical techniques, perioperative care, and integration with medical therapy have improved outcomes and quality of life. Optimal results depend on individualized decision-making within a multidisciplinary framework, with ongoing research needed to refine strategies for recurrence prevention and long-term functional preservation.

Keywords: Inflammatory bowel disease; Ulcerative colitis; Crohn’s disease; Ileal pouch-anal anastomosis; Bowel-sparing surgery

Core Tip: Surgical intervention remains an essential component of inflammatory bowel disease management despite advances in medical therapy. This narrative review synthesizes contemporary evidence on surgical indications, techniques, perioperative optimization, and postoperative outcomes in ulcerative colitis and Crohn’s disease. Emphasis is placed on bowel-sparing strategies, minimally invasive approaches, and quality-of-life outcomes, highlighting the importance of multidisciplinary, patient-centered decision-making.