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However, the risk of short bowel syndrome following multiple large resections makes bowel preservation strategies a major therapeutic priority. This review gathers insights from a diverse group of inflammatory bowel disease specialists, exploring the full spectrum of bowel-preserving strategies, from conservative surgical techniques and peri\u2013operative optimization to emerging innovations in robotic surgery. The therapeutic paradigm of treat-to-target and tight disease monitoring is shifting the focus from reactive interventions to proactive and personalized care. Looking ahead, the evolving implementation of multi\u2013omics profiling and artificial intelligence holds promise to reshape the role of surgery in CD. Surgery should no longer be viewed solely as a response to complications, but rather as an individualized, biology-driven strategy that prioritizes bowel preservation. In this rapidly advancing field, innovation is measured not only by clinical outcomes but also by every centimeter of bowel preserved.<\/jats:p>","DOI":"10.1093\/ecco-jcc\/jjaf208","type":"journal-article","created":{"date-parts":[[2025,11,22]],"date-time":"2025-11-22T13:01:09Z","timestamp":1763816469000},"source":"Crossref","is-referenced-by-count":0,"title":["From resection to preservation: redefining the surgical paradigm in Crohn\u2019s disease"],"prefix":"10.1093","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-0198-9144","authenticated-orcid":false,"given":"Giulia","family":"Migliorisi","sequence":"first","affiliation":[{"name":"IBD Center, Humanitas Research Hospital\u2014IRCCS , Rozzano, Milan,","place":["Italy"]},{"name":"Department of Biomedical Sciences, Humanitas University , Pieve Emanuele, 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