Anastomotic dehiscences after colorectal resections are serious complications following oncologic surgery and may require an individualized management. Colorectal Tube-in-tube Endoscopic Vacuum Therapy (CR TT-EVT) has emerged as a promising minimally invasive alternative for the treatment of these complications.

We report the case of a 72-year-old man who underwent a rectosigmoidectomy with extended left colectomy and primary mechanical colorectal anastomosis, without derivative stoma, for colon cancer treatment (pT4a pN2b M0, stage III). Because of a slow post-operative recovery, a rectoscopy was performed on the 21th day, revealing an anastomotic dehiscence, with cavity formation which allowed finding the lower mesenteric artery clip visualization. Intracavitary, transanal, CR TT-EVT was initiated. By the 13th day of treatment, a marked reduction in the dehiscence was observed, with only a small residual fistulous tract opening remaining. Given the confirmed closure of the cavity on CT imaging and the patient’s clinical improvement, therapy was interrupted and patient discharged. Adjuvant chemotherapy was initiated. Following his first chemotherapy cycle, 37-days after discharge, the patient was readmitted with fistula recurrence and fever. A new course of CR TT-EVT was then initiated and, once again, a remaining small fistulous opening was found on the 19^th day, when a full thickness clip (Padlock) was deployed to achieve complete closure and complete recovery.EVT is an effective minimally invasive strategy for managing anastomotic fistulas, even in cases of recurrence. Debate remains on when to interrupt it. However, pursuing complete closure should be the goal, mainly in the scenario of no diverting stoma. Whether achieved by continued vacuum therapy or with complementary techniques such as clipping.