Two Cases of Successful Fistula Closure for Anastomotic Leakage after Right Hemicolectomy Using an Over-The-Scope-Clip System

Anastomotic leakage after colorectal surgery is a severe postoperative complication. Although the treatment of anastomotic leakage is mainly percutaneous drainage, spontaneous closure of a fistula is occasionally delayed. We successfully treated two cases of anastomotic fistula after right hemicolectomy using the Over-The-Scope-Clip (OTSC®) system. In case 1, a 60-year-old woman underwent emergency laparoscopic right hemicolectomy for repeated diverticular bleeding. She developed a colocutaneous fistula secondary to postoperative anastomotic leakage. Since the fistula did not close after prolonged drainage, the OTSC® system was used to treat the fistula on day 112 postoperatively, and the fistula was completely closed. In case 2, an 85-year-old woman with ascending colon cancer and multiple liver metastases underwent right hemicolectomy combined with partial hepatectomy. She had an intra-abdominal abscess due to anastomotic leakage postoperatively. Conservative treatment of drainage did not result in spontaneous closure. The fistula was successfully closed using the OTSC® system. The OTSC® system can be an effective method for refractory anastomotic fistula after colorectal surgery.