The goal of the surgical management of Crohn's disease is to improve quality of life. Surgical management is generally reserved for patients who developed complications of the disease or who are unresponsive to or develop complications from aggressive medical therapy. Friable mesentery, inflammatory phlegmons, fistulas, abscesses, and adhesions from previous surgeries pose a surgical challenge to the laparoscopic approach. The laparoscopic approach to terminal ileal Crohn's disease is feasible and safe even in cases complicated by fistulas with previous abdominal surgery or recurrent disease. This approach is associated with an increased operative time compared to laparotomy, however, offers significant advantages over open ileocolic resection in terms of pulmonary function, length of hospital stay, duration of postoperative ileus, cosmesis, postoperative small bowel obstruction, and early postoperative complications. Laparoscopy is also associated with decreased overall hospitalization costs and improved patient satisfaction. Therefore, the laparoscopic approach for patients with Crohn's disease should be considered as the preferred operative approach.