Understanding a New Treatment for Fecal Incontinence in Children
Giovanni Parente, Valentina Pinto, Marco Pignatti, Neil Di Salvo, Simone D'Antonio, Michele Libri, Mario Lima · 2022
Fat Tissue Injection Offers Hope for Bowel Control Problems
Fecal incontinence—accidentally having bowel movements—can be deeply challenging for children and families. This condition affects children who have completed toilet training but struggle with bowel control. Causes include conditions present at birth, such as anorectal malformations, Hirschsprung disease, or spinal problems. When dietary changes and bowel management programs don't work, families often seek other options.
This research from a pediatric surgery team in Bologna, Italy, describes a new approach. The technique uses processed fat tissue from the child's own body to help improve bowel control.
How the Procedure Works: Echo-Guided Fat Injection
The treatment involves injecting specially prepared fat tissue between the sphincter muscles of the anus. Doctors use ultrasound imaging (echo guidance) to place the fat precisely where it's needed. The fat comes from the child's own body, making it completely compatible and reducing the risk of rejection.
The injected fat serves two important purposes:
Bulking effect: The fat tissue adds volume, which increases the resting pressure in the anal area
Sphincter support: It thickens the anal sphincter muscles, helping them function better
Studies using pressure measurements and ultrasound imaging have confirmed these effects in patients.
Why Fat Tissue Is Ideal for This Treatment
Fat tissue is much more than simple body fat. It contains several types of helpful cells:
Adipocytes: The main fat-storing cells
Mesenchymal stem cells (MSCs): Regenerative cells that may help rebuild tissue
Pericytes: Helper cells that support blood vessel health
Fibroblasts: Cells that help maintain tissue structure
Fat tissue makes an excellent treatment material because it is abundant in most people, including children. It can be collected through a minimally invasive procedure. Using the child's own tissue means there's no immune reaction or rejection risk.
Stem Cells May Provide Additional Healing Benefits
The researchers note that mesenchymal stem cells in the fat tissue may offer benefits beyond simple bulking. In other medical fields—including orthopedics and cosmetic treatments—these cells have shown the ability to help regenerate damaged tissue.
While scientists are still studying exactly how these cells work in anal sphincter treatment, they may help increase the number of muscle fibers in the sphincter. This could provide longer-lasting improvements in bowel control.
Treatment May Need to Be Repeated Over Time
One limitation of fat tissue injection is that the body gradually absorbs some of the transplanted fat. This means the treatment may need to be repeated to maintain its benefits. The amount of fat that survives varies from patient to patient, making results somewhat unpredictable.
However, the procedure remains attractive because it is minimally invasive and uses the child's own tissue. It offers a middle option between conservative treatments and more invasive surgery.
A Less Invasive Option Before Major Surgery
This technique gives doctors another tool for helping children with fecal incontinence. The treatment pathway typically follows these steps:
First, dietary changes and careful bowel management
If needed, transanal irrigation systems
For cases that don't respond, fat tissue injection
Major surgery remains available as a last option
The echo-guided approach allows precise placement of the fat tissue. Previous studies in adults have shown the technique to be safe and effective. This research extends those findings to children, offering families a new option when standard treatments aren't enough.
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Source: Parente et al., None, 2022.
Original Publication
Echo-Assisted Intersphincteric Autologous Microfragmented Adipose Tissue Injection to Control Fecal Incontinence in Children
Giovanni Parente, Valentina Pinto, Marco Pignatti, Neil Di Salvo, Simone D'Antonio, Michele Libri, Mario Lima · 2022
Echo-assisted intersphincteric autologous microfragmented adipose tissue injection (anal lipofilling) represents a novel minimally invasive technique for treating fecal incontinence in children who have failed conservative management with dietary changes and bowel management programs. This procedure is indicated for pediatric patients with true fecal incontinence secondary to congenital anomalies such as anorectal malformations, Hirschsprung disease, or spinal defects, prior to more invasive surgical interventions. The technique utilizes autologous adipose tissue, harvested from the patient, which is microfragmented and injected into the intersphincteric space under ultrasound guidance. The rationale is multifaceted: the injected fat acts as a bulking agent to increase resting anal pressure, thickens the anal sphincter complex, and potentially provides mesenchymal stem cells that may contribute to tissue regeneration and sphincter muscle fiber enhancement. Studies in adults have demonstrated the feasibility and safety of this approach, with anorectal manometry documenting increased resting pressures and anal endosonography confirming sphincter thickening. The main advantages include utilizing an abundant autologous tissue source with inherent stem cell content, minimally invasive application, and bridging the gap between conservative and major surgical management. Primary limitations include unpredictable fat graft viability and reabsorption, often necessitating repeated procedures to maintain clinical efficacy. Further studies are needed to elucidate the regenerative role of mesenchymal stem cells in this application.