Anti-tumor necrosis factor therapy has revolutionized the treatment of Crohn's disease. Despite the increased use in the past decade and a half, a majority of patients with Crohn's disease with ultimately require operative management of their disease. No clear consensus has been made in the literature regarding the surgical outcomes in patients who have been exposed to anti-tumor necrosis factor therapy. This review highlights the most recent and relevant literature regarding the safety and effects of anti-tumor necrosis factor use in the perioperative period.