Endoscopic recurrence after ileocecal or ileocolic resection in Crohn’s disease occurs in up to 70% of patients within one year without prophylactic therapy. Identifying risk and protective factors is crucial for patient management. This study aimed to assess recurrence rates and associated factors in a single-center cohort.

Retrospective study including Crohn’s disease patients undergoing ileocecal or ileocolic resection between 2000 and 2023, with endoscopic follow-up. Primary endpoint: endoscopic recurrence (Rutgeerts score). Statistical analysis was performed using SPSS 23.

Among 181 patients (113 women, 68 men; mean age 31 years), 56.9% had ileal disease and 43.1% had ileocolic disease; 43.1% had penetrating phenotype. Indications for surgery included stenosis (40%), penetrating disease (35%), obstruction (23%), and perforation (2%). Anastomosis was mainly end-to-side (84%), side-to-side in 4%. Preventive therapy was given to 78.5% (thiopurines 59.9%, anti-TNF 24.6%). Endoscopic recurrence occurred in 60.8% (i2 17.1%, i3 19.3%, i4 25.4%). Clinical recurrence was observed in 37%, and surgical recurrence in 18% after a median of 6 years.

Penetrating phenotype was identified as a risk factor, while side-to-side anastomosis (P=0.009) and early prophylactic therapy with thiopurines (P=0.027) or anti-TNF (P=0.011) were protective.

Endoscopic recurrence after ileocolic resection is frequent. Penetrating phenotype increases recurrence risk, whereas side-to-side anastomosis and early preventive therapy reduce it. Early endoscopic monitoring and tailored prophylaxis are essential to improve outcomes.