Background: Four meta-analyses exist evaluating the short term results of laparoscopic versus open ileocolic resection for Crohn’s disease. Little is known about the long term results of both procedures with respect to surgical recurrence rate, overall reoperation rate, incidence of incisional hernia, adhesive small bowel obstruction, quality of life (QOL) and Body Image (BI) and cosmesis. Aim: The objective of this study is to determine the long term results of a randomized multicenter study comparing laparoscopic with open ileocolic resection for Crohn’s disease.Materials and methods: Sixty patients who participated in this trial were prospectively followed in the outpatient clinic. Patients had an ileocolic resection between 1999 and 2003. Primary outcome parameters were overall reoperation and readmission rate and re-resection rate for recurrent Crohn’s disease. Secondary outcomes were QOL, BI and cosmesis.Results: Five patients, 1 from the laparoscopic group and 4 from the open group were lost to follow up. The groups were comparable for characteristics as sex, age, and maintenance therapy. Mean follow-up was 6.8 years. Overall, 16/29 (55%) and 16/26 (62%) patients remained relapse-free after the ileocolic resection in the laparoscopic and open group respectively (p=NS). Resection of recurrent Crohn’s disease occurred in 2/29 (7%) and 3/26 (12%) patients (p=NS). Two reoperations for incisional hernia were done in the open group (2/26= 8%) vs. nil in the laparoscopic group. Reoperation for adhesive small bowel obstruction was done twice in the open group (2/26=8%) vs. nil in the laparoscopic group. Overall reoperation rate was 2/29 (7%) versus 7/26 (27%) in the laparoscopic and open group respectively (p=0.047). QOL was similar in both groups. BI and cosmesis scores were significantly higher in the laparoscopic group (p=0.029 and p=0.000 respectively).Conclusions: Surgical recurrence and QOL after laparoscopic and open ileocolic resection for Crohn’s disease are comparable. Overall reoperation rate was significantly higher in the open group. Laparoscopic-assisted ileocolic resection was associated with a significantly better BI and cosmesis.