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Modifications in host immune response have been demonstrated in both the pathogenesis of Crohn’s disease (CD) and after laparoscopic resections for cancer. Relationships between surgical approaches and the rates and severity of CD recurrence after ileo-colonic resection (IC) are unknown. Aim of this study was to compare 2 groups of CD patients undergoing either laparoscopic or open IC to verify whether the surgical approach might influence the recurrence rate of the population of study. Patient’s satisfaction with regard to the treatment received was also analysed. 80 consecutive patients undergoing elective IC by either laparoscopic approach (LAP=30; 38%) or conventional open surgery (OPEN=50; 62%) were enrolled in a prospective longitudinal study. Study protocol includes 3-years follow up (FU). Recurrence was investigated by CD activity index and clinical examination every 6 months and colonoscopy at 12 and 36 months in all patients. At 12 and 36 months patients were also asked to fill out a specific Treatment Satisfaction Questionnaire. We have already reported short term results and results of the 1st year of FU in a previous comparative study that included 28 patients from this series. In this study we have analysed the results from the 3rd year of FU. Fisher’s exact test and t-test were used to statistically compare qualitative and quantitative data respectively.62 patients completed 3-years follow up (FU) (RANGE 3-6 years) and of these, 60 (97%) underwent a colonoscopy with ileoscopy. For 18 patients (23%) the 3-years FU is still in progress. Clinical recurrence at 3 years was 2 (9%) in the LAP and 3 (8%) in the OPEN group. Endoscopic recurrence according to Ruttgers score was seen in 14(63%) patients in the LAP group and in 27(69%) in the OPEN group. The frequency, severity and pattern of recurrence did not differ between the 2 groups (p=0.6). Three patients (1 in the LAP group and 2 in the OPEN group; tot. 4%) underwent re-resection during the FU period and 1 patient in the OPEN group underwent incisional hernia repair. No significant differences in terms of readmissions or need for medication were seen during the FU period. However patients’ satisfaction was still significantly in favour of laparoscopy also in the long-term assessment.No differences were observed in terms of frequency, time-of-onset and severity of recurrence in a 3-years follow up in this consecutive series of patients undergoing laparoscopic vs open IC. Hence long-term outcome for laparoscopy are comparable to standard procedure. However treatment’s satisfaction assessment showed a strongly significant preference of patients for the mini-invasive approach due to better cosmetic results, hospital experience and surgical treatment acceptance. Laparoscopic IC should be offered to CD patients referred for surgery even though doesn’t seems to influence disease recurrence