THERAPEUTICAL NOTE   

Chirurgia 2022 February;35(1):51-4

DOI: 10.23736/S0394-9508.21.05271-2

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Autologous micro-fragmented fat injection results in cases of complex perianal fistula in patients with Crohn’s disease

María J. SEGURA ¹ ✉, Rafael ALÓS ², Amparo SOLANA ¹, Marina ALARCÓN ¹, María D. RUIZ ¹, Roberto LOZOYA ¹

¹ Hospital de Sagunto, Valencia, Spain; ² Hospital La Fe, Valencia, Spain

BACKGROUND: The presence of complex perianal fistulas in Crohn’s disease (CD) determines important morbidity due to their difficult management, their high rate of recurrence and, in many cases, the failure of all available resources. It has been described that adipose tissue contains adult mesenchymal stem cells that can improve results in this type of patient. The aim of this study is to present our results of the adjuvant use of this therapy in complex perianal fistulas in patients with CD when other types of treatment have failed.
METHODS: Five patients with complex perianal fistulas and CD are presented, with a total of eight fistulas. In all cases, a curettage of the fistulous tract and closure of the internal fistulous orifice (IFO) was performed. Abdominal fat tissue was obtained by liposuction (180-210 mL) and processed with Lipogems™ device. Finally, 15-20 mL were obtained and injected around the IFO and the fistulous tract.
RESULTS: With an average follow-up of 22 months (9-35), complete healing has been obtained in six of the eight fistulas (75%), one of which is rectovaginal. In 25% of cases the fistula persists but there is no suppuration.
CONCLUSIONS: According to our results, injection of micro-fragmented and processed autologous fat with Lipogems™ device may be a valid treatment option for patients with CD and complex perianal fistula that do not respond to other therapies. Further studies and long-term follow-up are needed to confirm these results.

KEY WORDS: Rectal fistula; Mesenchymal stem cells; Crohn disease