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This review presents an up\u2010to\u2010date summary of the literature in the field and points to a role for bacterial overproliferation in recurrence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The literature (Medline, Embase, and the Cochrane Library, 1971\u20132009) on ileal CD and postoperative recurrence was searched, and 528 relevant articles were identified and reviewed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Smoking is a key independent risk factor for recurrence. NOD2\/CARD15 polymorphisms and penetrating phenotype are associated with aggressive disease and higher reoperation rates. Age at diagnosis, disease duration, gender, and family history are inconsistent predictors of recurrence. Prophylactic 5\u2010aminosalicylic acid therapy and nitromidazole antibiotics are beneficial. Combination therapies with immunosuppressants are also effective. Anti\u2010TNF\u03b1\u2010based regimens show benefit but the evidence base is small. Corticosteroid, interleukin\u201010, and probiotic therapies are not effective. Wider, stapled anastomotic configurations are associated with reduced recurrence rates. Strictureplasty and laparoscopic approaches have similar long\u2010term recurrence rates to open resection techniques. Length of resection and presence of microscopic disease at resection margins do not influence recurrence. A lack of consensus exists regarding whether the presence of granulomas or plexitis affects outcome.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Current evidence points to defects in mucosal immunity and intestinal dysbiosis of either innate (<jats:italic>NOD2\/CARD15<\/jats:italic>) or induced (smoking) origin in postoperative CD recurrence. Prophylactic strategies should aim to limit dysbiosis (antibiotics, side\u2010to\u2010side anastomoses) or prevent downstream chronic inflammatory sequelae (anti\u2010inflammatory, immunosuppressive, and immunomodulatory therapy).<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-010-0504-6","type":"journal-article","created":{"date-parts":[[2010,3,1]],"date-time":"2010-03-01T21:29:52Z","timestamp":1267478992000},"page":"1615-1626","source":"Crossref","is-referenced-by-count":38,"title":["Postsurgical Recurrence of Ileal Crohn\u2019s Disease: An Update on Risk Factors and Intervention Points to a Central Role for Impaired Host\u2010Microflora Homeostasis"],"prefix":"10.1002","volume":"34","author":[{"given":"Michael F.","family":"Cunningham","sequence":"first","affiliation":[{"name":"Surgical Professorial Unit St Vincent\u2019s University Hospital Elm Park Dublin 4 Ireland"},{"name":"UCD School of Medicine and Medical Sciences University College Dublin Dublin Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neil G.","family":"Docherty","sequence":"additional","affiliation":[{"name":"Department of Physiology School of Medicine Trinity College Dublin Dublin Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. Calvin","family":"Coffey","sequence":"additional","affiliation":[{"name":"Surgical Professorial Unit St Vincent\u2019s University Hospital Elm Park Dublin 4 Ireland"},{"name":"UCD School of Medicine and Medical Sciences University College Dublin Dublin Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John P.","family":"Burke","sequence":"additional","affiliation":[{"name":"Surgical Professorial Unit St Vincent\u2019s University Hospital Elm Park Dublin 4 Ireland"},{"name":"UCD School of Medicine and Medical Sciences University College Dublin Dublin Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P. 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