Endoluminal clip closure of a circular full-thickness colon resection in a porcine model (with videos)

BackgroundLinear perforations of the colon can be closed by the application of clips through a colonoscope. It is unclear whether circular perforations after full-thickness resection of the colon can be closed with clips.ObjectiveTo develop an animal model for circular perforation of the colon and to study different techniques to accomplish a leakproof sealing of the circular perforation of the colon.DesignPilot study.SettingUniversity medical center.AnimalsTen pigs: 2 perforations in the 1st pig and 1 perforation in the 2nd to 9th pigs were closed with clips. In the 10th pig, 5 perforations were created, and the dimensions of the perforation were measured.InterventionsCreation of a circular full-thickness resection of the colon with a band-ligation–resection device, followed by longitudinal or transverse endoluminal closure of the perforation by using the first clip opened and applied in the 3- to 9-o'clock or the 6- to 12-o'clock direction in relation to the circular perforation, respectively.Main Outcome MeasurementsThe mean (standard deviation) size of circular perforation was 1.7 ± 0.075 cm (range, 1.5–2.0 cm). Necropsy immediately after closure of the perforation was done to examine the closure and to confirm the quality of sealing with the methylene blue dye leak test.ResultsThe transverse closure was unsuccessful in the closure of 3 perforations, whereas the longitudinal closure resulted in a leakproof sealing in 6 of the 7 closures.LimitationsPerforation of the adjacent viscera limits it to a nonsurvival study.ConclusionsEndoluminal application of clips by using the longitudinal closure technique results in a leak proof sealing of circular perforations of the colon.