The incidence of Crohn disease (CD) has been increasing and surgery needs to be contemplated in a substantial number of cases. The relevant advent of biological treatment has changed but not eliminated the need for surgery in many patients. Despite previous publications on the indications for surgery in CD, there was a need for a comprehensive review of existing evidence on the role of elective surgery and options in pediatric patients affected with CD. We present an expert opinion and critical review of the literature to provide evidence-based guidance to manage these patients. Indications, surgical options, risk factors, and medications in pre- and perioperative period are reviewed in the light of available evidence. Risks and benefits of surgical options are addressed. An algorithm is proposed for the management of postsurgery monitoring, timing for follow-up endoscopy, and treatment options.

*Department of Pediatrics Centro Hospitalar S João Porto Portugal †Children's Hospital Zagreb Faculty of Medicine Zagreb Croatia ‡The Juliet Keidan Institute of Pediatric Gastroenterology and Nutrition Shaare Zedek Medical Center The Hebrew University of Jerusalem Jerusalem Israel §Department of Pediatrics Hvidovre University Hospital Hvidovre Denmark ||Pediatric Surgery Children's Hospital University of Helsinki Helsinki Finland ¶Department of Pediatric Gastroenterology University Hospital Southampton Southampton UK Department of Pediatric Gastroenterology and Nutrition Medical University of Warsaw Warsaw Poland **Department of Pediatrics University Hospital Motol Prague Czech Republic ††Queen Mary's Hospital for Children Epsom and St Helier NHS Trust Surrey ‡‡Chelsea and Westminster Hospital London UK §§Paris Diderot Sorbonne Paris Cité University and Robert Debré Hospital Paris France ||||Pediatric Gastroenterology and Hepatology Dr von Hauner Children's Hospital Ludwig Maximilians University Munich Germany ¶¶St George's University of London London UK Boston Children's Hospital and Harvard Medical School Boston MA ***Department NEUROFARBA University of Florence Meyer Hospital Florence Italy †††Unit for the Comprehensive Care of Pediatric Inflammatory Bowel Disease Hospital Sant Joan de Déu Barcelona Spain ‡‡‡Department of Pediatric Gastroenterology Necker Enfants Malades University Hospital Sorbonne Paris Cité University Paris Descartes University Institut IMAGINE INSERM U1163 Paris France §§§Pediatric Gastroenterology Institute Ruth Children's Hospital Rambam Medical Center Haifa Israel ||||||Department of Pediatric Gastroenterology Bristol Royal Hospital for Children Bristol UK ¶¶¶Department of Translational Medical Science Section of Pediatrics University of Naples Federico 2 Naples Italy Department of Pediatric Surgery Leeds Children's Hospital Leeds General Infirmary Leeds UK ****Child Life and Health University of Edinburgh Scotland UK ††††MassGeneral Hospital for Children Harvard Medical School Boston MA ‡‡‡‡Children's Hospital University of Helsinki Helsinki Finland

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