BACKGROUND: The observation that in more than 90% of Crohn’s disease patients the postoperative recurrences are located in the pre-anastomotic tract leads us to suppose that the anastomosis would play a role in the appearance of recurrences. AIM AND METHODS: To focus the role of different anastomotic configurations in the incidence of recurrences, the Authors have conducted a review of the literature of the last two decades and have revised critically their experience. RESULTS: The rate of recurrences seem to be lower in patients in whom the anastomotic configuration is such as to present a wide lumen; it seems that they are lower after stapled side-to-side anastomosis. The Kono-S anastomosis, recently introduced technique, seems to offer better results. CONCLUSIONS: The role of the various types of anastomosis remains uncertain. Further large-scale controlled trials with long term follow-up are needed.