Background <p>Robotic approach is increasingly being used for surgery in Crohn’s disease. Robotic ileocolic resection (ICR) for Crohn’s disease (CD) is comparable to laparoscopic ICR for short term outcomes; however, no studies have compared longer-term recurrence rates between these approaches.</p> Objective <p>The objective was to compare longer-term recurrence rates between these approaches.</p> Methods <p>We performed a retrospective cohort study using a deidentified single institution research database containing data extracted from the electronic health record. We included all patients with CD who underwent minimally invasive ICR between 2017 and 2024. The primary outcome was endoscopic recurrence within 18 months postoperatively, defined as Rutgeerts score ≥ i2. The time-to-event analysis was performed to compare time to endoscopic recurrence between laparoscopic versus robotic ICR.</p> Results <p>A total of 164 patients were included in study, with a predominant majority prescribed an advanced medical therapy postoperatively (93.9%). Within 18 months postoperatively, 22/164 (13.4%) patients experienced endoscopic recurrence: 16/127 (12.5%) in the laparoscopic cohort and 6/37 (16.2%) in the robotic cohort. In the time-to-event analysis, there was no statistically detectable difference in Kaplan–Meier curves compared between laparoscopic and robotic ICR (log rank <i>p</i> = 0.115). In multivariable Cox proportional hazards models adjusted for smoking history and history of ICR, there was no statistically detectable difference in endoscopic recurrence rates within 18 months postoperatively compared between laparoscopic and robotic ICR (HR 1.12, 95% CI 0.341–3.74, <i>p</i> = 0.842).</p> Conclusions <p>In this retrospective cohort, no statistically detectable differences in endoscopic recurrence between approaches was observed; however, conclusions are limited by small sample size, low event rates, and widespread postoperative biologic use and should be interpreted as exploratory only..</p>