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

Background: Linear 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. Objective: To 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. Design: Pilot study. Setting: University medical center. Animals: Ten 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. Interventions: Creation 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 Measurements: The 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. Results: The 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. Limitations: Perforation of the adjacent viscera limits it to a nonsurvival study. Conclusions: Endoluminal application of clips by using the longitudinal closure technique results in a leak proof sealing of circular perforations of the colon.