Work

Injection of Freshly Harvested Autologous Fat for the Treatment of Complex Anorectal Fistula: a Safe and Promising Experience

Year: 2024

Type: article

Abstract: Introduction Complex anorectal fistulas present a significant challenge for colorectal surgeons. Surgical treatment aimed at a cure carries a risk of fecal incontinence of up to 40%. Sphincter-sparing techniques reduce this risk but increase the recurrence rate of fistulas. Treatment with autologous mesenchymal stem cell (MSC) injection has shown promise, with a 57% cure rate within one year. However, it requires laboratory centers with expertise in cell culture, which limits its accessibility. A potential solution is the use of allogeneic stem cells, which, while producing similar results, comes at a high cost (up to $87,000). The injection of freshly harvested autologous adipose tissue for the treatment of complex fistulas has emerged as an alternative. This technique is cost-effective, performed in a single surgical session, sphincter-sparing, and has outcomes comparable to MSC and allogeneic stem cell injections. Objectives To evaluate the efficacy and safety of treating complex anorectal fistulas with freshly harvested autologous adipose tissue injection. Methodology We conducted an analysis of electronic medical records for all patients who underwent this treatment at a tertiary hospital. Variables analyzed included clinical cure, reduction in secretion drainage, and postoperative complications. Patients lost to clinical follow-up were excluded from the study. Results To date, six patients were included, all of whom had undergone at least two previous procedures with fistula recurrence. Among these, five showed clinical response to the treatment. Four met the criteria for clinical cure (closure of the external opening, cessation of secretion drainage, and absence of a palpable internal opening), and one demonstrated complete healing of two external openings while retaining one external opening with significantly reduced secretion drainage. One patient reported no clinical improvement and was the only individual with an ostomy. None of the patients were smokers. One patient with clinical cure developed soiling, which had not been reported preoperatively. Conclusion Freshly harvested autologous fat injection is a safe, accessible, and promising technique. This study has the inherent limitations of a prospective observational single-center study but confirms the feasibility of the technique and positive results at a Brazilian tertiary hospital. These results can be reproduced safely in other Latin American centers, making this approach a valuable addition to the therapeutic arsenal of colorectal surgeons. Publication History Article published online: 25 April 2025 © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/) Thieme Revinter Publicações Ltda. Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

Source: Journal of Coloproctology

DOI: 10.1055/s-0045-1808883