Endoscopic management of colorectal anastomosis refractory leaks: a journey from conventional to inventive approaches.

Background and Aims: Postsurgical leaks are a dreaded adverse event of colorectal surgery. Traditional surgical approaches, including temporary ileostomy and revisional surgery, are the preferred methods for managing these challenging leaks. However, with the development of less-invasive techniques associated with lower morbidity, the combined use of temporary ileostomy and endoscopic therapies is on the rise. Although surgical management and endoscopic traditional therapies are often successful, alternative approaches are necessary when both approaches fail. Methods: This is the first case report of a patient with a chronic colorectal anastomotic leak with an associated contained collection successfully treated with magnetic anastomosis to provide internal drainage. Results: A 60-year-old man who underwent surgical treatment of a rectal adenocarcinoma presented with a dehiscence of the suture line with an associated contained collection. He underwent 2 surgical revisions and several conventional endoscopic therapies to treat this adverse event with no successful closure. Thus, endoscopic internal drainage with magnetic anastomosis followed by septotomy and endoscopic vacuum therapy for 1 week were successfully performed. At the 6-month follow-up, rectoscopy showed a normal rectal/colonic tubular shape without any signs of transmural defects and stenosis. Conclusions: Endoscopic internal drainage is a safe and effective strategy for managing leaks associated with contained collections. After conventional techniques fail, the use of magnets for internal drainage by an anastomosis between the collection and the lumen appears to be an attractive option. This approach has the potential to enhance patient outcomes, improve quality of life, and reduce morbidity. Further research is required to validate our findings.