This retrospective study determined whether a hand-sewn or stapled anastomosis leads to a greater recurrence rate in patients undergoing ileocecal resection for terminal ileal Crohn's disease. The effects of oral contraceptive use, smoking, and age at onset of disease were also examined. Ninety-two patients with Crohn's disease of the terminal ileum whose first operation was an ileocecal resection (terminal ileum and right colon up to but not including the hepatic flexure) were studied for symptomatic and operative recurrence. The symptomatic recurrence rates were 15% at 1 year, 31% at 2 years, and 45% at 3 years. The operative recurrence rates were 6% at 1 year, 14% at 2 years, and 22% at 3 years. The type of anastomosis, whether hand-sewn or stapled, did not affect the rates of symptomatic (P = 0.3) or operative (P = 0.6) recurrence. After the initial resection smoking affected both symptomatic (P = 0.03, risk ratio = 2.380) and operative (P = 0.041, risk ratio = 3.13) recurrence, but there was no effect of age at onset of disease or use of the birth control pill.