Laparoscopic surgery is associated with reduced long-term reoperation risk in Crohn’s disease

Abstract Background Minimally invasive surgery (MIS) improves short-term outcomes in Crohn’s disease (CD), but its impact on long-term surgical recurrence is uncertain. Methods The objective of this study was to assess risk factors for surgical recurrence after intestinal resection for CD, with emphasis on surgical approach. A retrospective single-centre study of patients undergoing elective intestinal resection for CD between 1995 and 2020 was conducted. Demographics, disease features, surgical details and complications were analysed. Recurrence was assessed using Kaplan–Meier and Cox regression. Results A total of 641 patients were included, with a mean follow-up of 12.4 years. Mean age at surgery was 38.3 years; mean disease duration was 11.5 years. Laparoscopy was performed in 270 patients, and open surgery in 371. Cumulative recurrence was 25% at 25 years. Kaplan–Meier analysis demonstrated lower cumulative surgical recurrence rates following laparoscopic compared with open surgery (log-rank p = 0.010). In multivariate Cox regression analysis, open surgery was associated with a higher hazard of surgical recurrence (HR 1.76, 95% CI 1.14–2.69), alongside smoking, female sex and microscopically inflamed resection margins. Severe perioperative complications (7.0% overall; 3.3% laparoscopic versus 9.7% open) did not influence recurrence ( p = 0.574). Conclusions Laparoscopic surgery was associated with longer reoperation-free survival and a lower hazard of surgical recurrence in this long-term cohort. Surgical approach may represent a potentially modifiable factor in optimising long-term outcomes in Crohn’s disease, alongside smoking cessation and achieving microscopically clear resection margins.