Over the scope clip vs. King closure (endoloop + clips) for rectotomy closure. A randomized experimental survival study

Aims & Methods: The aim of our study was to compare two techniques of an access site closure in the rectum: over-the-scope clip vs. single endoloop with endoclips (KING closure). The pigs underwent a NOTES transrectal peritoneoscopy with liver biopsy. The rectotomy was closed using an over-the scope clip in 10 pigs or using a KING closure in 10 pigs. The necropsy was performed 28 days thereafter. Outcome variables were feasibility, safety, effectiveness and cost. Results: All closures were successfully completed and assessed as safe. The median times of closure (IQ range) were 9.5 (8-12) minutes in the KING group vs. 9 (7-10) minutes in the OVESCO group (NS). All animals recovered well and there was no mortality. At necropsy, no animal presented with signs of peritonitis and all closure sites were completely healed. Histological examination showed full thickness closures. Three animals (30%) in the KING group developed small abscess not related to the closure site. In the OVESCO group, one pig (10%) developed an abscess between the spleen and abdominal wall. In 1 pig in the OVESCO group, an enterocolic fistula developed in the proximity of the closure site. The cost was higher for the OVESCO clip (430 EUR, with a grasper 906 EUR) than for the KING closure (203 EUR). Conclusion: OVESCO clip and KING closure technique are comparable techniques for the closure of a rectal access site in terms of the technical feasibility, safety and effectiveness.