Anastomotic dehiscence remains one of the most severe and potentially fatal complications following colorectal surgery. Despite technical advances and improved perioperative care, its incidence remains around 11% and is associated with high morbidity (2-16%) and mortality rates (20-35%).¹

In recent decades, endoscopic vacuum therapy (EVT) has become a minimally invasive and effective option for managing anastomotic fistulas and leaks, preserving anastomosis and reducing the need for reoperations.²

The conventional EVT method, described in 2001, uses a sponge attached to a catheter inserted transanally and positioned intraluminally or intracavitary, connected to a continuous, controlled negative-pressure system.³

In 2019, the Tube-in-Tube Endoscopic Vacuum Therapy (CR TT-EVT) technique was introduced, allowing vacuum system placement without sponge, transanally or throught transparietal access. Its structural features eliminate the need for frequent device exchanges and allow cavity irrigation, improving infectious control and wound healing.⁴

The aim was to evaluate technical success, clinical success, and adverse events associated with the CR TT-EVT method in the management of colorectal anastomotic dehiscence.

This retrospective observational study was conducted at the São Paulo Cancer Institute and included patients  with colorectal anastomotic dehiscence treated with CR TT-EVT between 2019 and 2024.

Thirty patients with colorectal anastomotic dehiscence were treated using CR TT-EVT, 70% were male and the mean age was 58 years. Twenty-six were operated for colorectal cancer, three for diverticulitis, and one for endometriosis.Diagnosis was predominantly established by computed tomography (93%), and the mean volume of associated collections was 203mL. 

CR TT-EVT was used as primary therapy in 21 patients and as rescue therapy after failure of initial treatment in nine. Seventeen had a protective ostomy at the time of diagnosis. Treatment access was mainly throught transparietal (20 patients), followed by transanal (nine) and intraluminal via colostomy (one).

The median interval between surgery and diagnosis of dehiscence was 8 days, and between diagnosis and CR TT-EVT initiation, 5 days. Technical and clinical success were 100% and 87%, respectively, with median time therapy  of 21 days, and an average of three rectoscopies per patient. Eleven patients required additional therapy, but none required reoperation. Thirteen patients underwent treatment without an ostomy.

The most frequent complication was device displacement when positioned transanally (27%). Three patients developed anastomotic stenosis - two successfully treated with endoscopic dilation. One patient developed complete anastomotic stenosis requiring permanent colostomy. One patient died during late therapy, without evidence of pelvic infection.

CR TT-EVT demonstrated high efficacy and safety in the management of colorectal anastomotic dehiscence, with no need of surgery. Adverse events were infrequent, mainly limited to device displacement, and anastomotic stenosis, mostly endoscopically manageable. The relationship between time for defect to closing and the limited need for device exchanges, highlights the potential advantages of CR TT-EVT.

These findings support CR TT-EVT as an effective minimally invasive strategy, that optimizes the management of colorectal fistulas and anastomotic leaks, avoiding unnecessary surgical interventions.