OBJECTIVE To summarize current knowledge on surgical therapy in patients with inflammatory bowel disease (Crohn's disease, ulcerative colitis and diverticulitis). METHODS To discuss surgical indications and strategies, we reviewed major peer review publications of the last 10 years, and we also analysed data from patients with Crohn's disease who were treated in our institution between 1978 and 1994. RESULTS With Crohn's disease (305 patients), emergency surgery should be avoided as much as possible, since morbidity (50% vs 8.8%) and mortality (11% vs 0.6%) rise significantly in comparison to elective procedures. With ulcerative colitis, operative therapy is indicated in patients with secondary malignoma, and urgent surgery is requested in cases with associated perforation, toxic megacolon or massive bleeding. With diverticulitis, the first episode should be managed conservatively. Surgery is indicated in patients with recurrent episodes or with secondary complications. CONCLUSIONS For treating patients with Crohn's disease or with diverticulitis, an indication for surgery should not be delayed and should be made before complications develop to avoid high risk emergency surgery. Elective surgery in patients with ulcerative colitis usually consists in proctocolectomy. Individual findings and aspects will determine the decision whether to construct an ileoanal pouch or whether ileostoma is more appropriate.