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

Minimally invasive surgery (MIS) improves short-term outcomes in Crohn's disease (CD), but its impact on long-term surgical recurrence is uncertain.

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.

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).

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.