Autologous adipose-derived stromal vascular fraction and platelet concentrates for the treatment of complex perianal fistulas

• Published in: Techniques in coloproctology Vol. 27; no. 2; pp. 135 - 143
• Main Authors: Tutino, R., Di Franco, S., Massani, M., Bonventre, S., Mazzola, G., Lo Re, G., Gulotta, E., Kamdem Mambou, L. J., Stassi, G., Cocorullo, G., Gulotta, G.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.02.2023; Springer Nature B.V
• Subjects: Abdominal Surgery; Adipose Tissue; Adult; Anal Canal - surgery; Colorectal Surgery; Cutaneous Fistula; Fecal incontinence; Female; Fistula; Gastroenterology; Humans; Injections; Male; Medicine; Medicine & Public Health; Original; Original Article; Proctology; Quality of Life; Rectal Fistula - surgery; Surgery; Treatment Outcome; Cryptoglandular; Platelet concentrates; Perianal fistula; Surgery; Stromal cells
• ISSN: 1123-6337; 1128-045X
• DOI: 10.1007/s10151-022-02675-0

Background Complex perianal fistulas are a major challenge for modern surgery since 10–35% of patients have functional problems after treatment. Sphincter-saving techniques have a wide range of efficacy (10–80%). We hypothesised that autologous adipose-derived stromal vascular fraction in combination with platelet rich plasma is a new therapeutic strategy with enhanced cure and function preservation rates. Methods Adult patients with complex cryptoglandular perianal fistulas were treated with injection of autologous adipose-derived stromal vascular fraction in combination with platelet rich plasma around and inside the fistulous tract between May 2018 and April 2019 at the General and Emergency Surgery Operative Unit of the University Hospital “P. Giaccone” of Palermo. Fistulas were confirmed by magnetic resonance imaging. Patients completed the Short Form-36 score on quality of life and the Wexner and Vaizey scores on faecal incontinence, and they were functionally studied using a three-dimensional anorectal manometry. The clinical and functional follow-up was performed at 1 year and 2 years after surgery. Results Nine patients (4 males, 5 females; median age 42 years [19–63 years]) with high trans-sphincteric or horseshoe fistulas were treated. The average number of previous surgeries per patient was 4.8. At 1 year follow-up, 77.7% of patients were cured, while at 2 years there was 1case of relapse. The variation in Short Form-36 score in cured patients was not significant ( p  = 0.0936). No statistically significant differences were found in continence scores. Conclusions The proposed treatment is a treatment option that preserves sphincter integrity and function, potentially avoiding postoperative incontinence and the need of repeated treatments.