“…Once the patient has been referred for surgery and surgery has been decided upon, it is the surgeons' role to directly optimize the patient the best they can, with nutritional supplementation, prehabilitation, and educating the patient on the operation and expected postoperative course as many anxieties of surgery are secondary to the unknowns surrounding the operation. 42 Once in the operating room, a minimally invasive approach should be attempted, if safe; however, the intra-abdominal pathology, such as fistulae, sepsis, or the thickness and friability of the mesentery will dictate if the operation can be completed minimally invasive, or if a hybrid or open approach will be needed for a safe operation. If the terminal ileum (TI) is grossly diseased, (i.e., adherent to the right lower quadrant retroperitoneum), it behooves the surgeon to start the dissection away from the involved tissue and "circle the pathology," typically by mobilizing the hepatic flexure and medializing the ascending colon and possibly the descending/sigmoid colon in the case of an ileosigmoid fistula.…”