Surgery remains frequent in patients with Crohn’s disease (CD), with a potential cumulative risk of short bowel syndrome. The aim of our study was to evaluate the correlation between the Rutgeerts endoscopic score and clinico-endoscopic recurrence during the first year following intestinal resection in patients with CD.

We conducted a retrospective analytical and descriptive study within the Department of Hepato-Gastroenterology and Proctology, including all patients with CD who underwent ileocecal or right ileocolic resection between 2019 and 2024. Patients without postoperative colonoscopy were excluded. Postoperative endoscopic recurrence was defined as a Rutgeerts score ≥ i2.

A total of 92 patients were included. The mean age was 41.3 years (20–72 years), with a slight female predominance (F/M sex ratio = 1.19; 50 women and 42 men). The mean interval between CD diagnosis and surgery was 2.6 years. Six patients (6.5%) were smokers.

Disease location was ileocecal in 50% of patients (n = 59), ileocolic in 44.5% (n = 41), ileal in 4.3% (n = 4), and extensive in 1%. The phenotype was stricturing in 64.1% (n = 59), penetrating in 18.4% (n = 17), mixed stricturing/penetrating in 14.1% (n = 13), and inflammatory in 2 cases.

Thirty-three patients (35.8%) had perianal Crohn’s disease, including: complex fistulas: 29 patients (31.5%) anal ulcerations: 2 patients (2.1%) anal stenosis: 1 patient (1%) anal fissure: 1 patient (1%)

Indications for surgery were ileal or ileocecal stricture in 73.9% of patients (n = 59), internal or external fistulas in 20.6% (n = 19), and deep abscess in 2 patients.

Postoperative colonoscopy was performed after a mean of 9.2 months (6–11 months). Endoscopic recurrence (Rutgeerts ≥ i2) was observed in 59.7% of patients (n = 55), distributed as follows: Rutgeerts i2: 20 patients (21.7%) Rutgeerts i3: 9 patients (9.7%)• Rutgeerts i4: 26 patients (28.2%)

Clinical recurrence occurred in 53.2% of patients (n = 49).

In univariate logistic regression analysis, statistically significant predictors of clinical recurrence were:Rutgeerts score ≥ i2 (p < 0.001) presence of perianal disease (p = 0.042)

In multivariate analysis, only a Rutgeerts score ≥ i2 remained significantly associated with clinical recurrence (p < 0.001).

Endoscopic recurrence of Crohn’s disease assessed by the Rutgeerts score is strongly correlated with the risk of clinical recurrence. These findings highlight the predictive value of the Rutgeerts score in postoperative monitoring and support early therapeutic optimization in high-risk patients.