Quality of life (QOL) improves rapidly in patients undergoing uncomplicated abdominal surgery for Crohn’s disease (JACS 2003). AIM: To determine influence of postoperative complications on long-term QOL in patients undergoing abdominal surgery for Crohn’s disease. METHODS: From 1996 through 2002, 347 abdominal operations were performed for Crohn’s disease in 305 patients at our institution. Patients with postoperative complications (n=66) were categorized into minor and major complications. A standardized questionnaire determining general well-being and four well-established, validated QOL instruments (SF-36, Gastrointestinal QOL Index, Cleveland Global QOL score, Short Inflammatory Bowel Disease Questionnaire) were sent to the 66 patients who had a postoperative complication and to 66 randomly chosen controls who underwent abdominal surgery for Crohn’s disease with uneventful postoperative recovery. RESULTS: Questionnaires were returned from 46 patients with complications (73%) at a postoperative follow-up (mean [range]) of 43 months [12-96 mo] and from 43 controls (65%) at a follow-up of 49 months [19-101 mo]. Age, sex, duration of disease, number of patients with previous surgery, and follow-up did not differ between groups. 31 minor complications (urinary tract infection 17, postoperative ileus 9, wound infection 4, and pneumonia 1) and 17 major complications (7 anastomotic leaks, 7 intraabdominal abscesses, and 1 each with postoperative intraabdominal hemorrhage, mechanical bowel obstruction, and pulmonary embolism) occurred in the 46 patients with complications. All major complications required re-operation, except the patient with pulmonary embolism and 5 with intraabdominal abscess, treated with a CT-guided drainage and antibiotics. Hospital stay was prolonged after minor and major complication (21 days [4-52 d] and 44 days [10-252 d] vs. 13 days [6-25 d] in controls; p<0.05). No differences were observed at time of follow-up between groups for all four applied QOL instruments except for the domain “physical functioning” in the SF-36, where scores (mean±SEM) for patients with major, minor, and no complications were 70±4%, 69±5%, and 83±3%, respectively (p<0.05). Postoperative complications did not affect the presence of symptoms due to Crohn’s disease at the time of follow-up (minor 65%, major 56% vs. controls 70%; ns.). CONCLUSION: Postoperative complications after abdominal surgery for Crohn’s disease prolong hospital stay, although long-term QOL seems not to be affected in large part. The aspect of “physical functioning” may, however, deteriorate.