Fat Tissue Injection Offers Hope for Stubborn Crohn's Fistulas

Two-thirds of patients achieved complete healing at six months

This Italian study tested a new approach for people whose Crohn's perianal fistulas hadn't healed despite standard treatments. Researchers treated fifteen patients with complex fistulas using micro-fragmented adipose tissue (specially processed fat from the patient's own body). The results were encouraging: ten out of fifteen patients (67%) achieved complete remission. This means their fistula openings closed and MRI scans showed healing inside the tissue.

Standard treatments had already failed these patients

Every patient in this study had already tried the current gold-standard treatment approach. This includes surgical drainage combined with biologic medications like anti-TNF drugs. They had received these treatments for at least one year without success. Some had also undergone additional "rescue" surgeries. These were truly difficult cases where doctors had run out of conventional options.

The challenge with complex Crohn's fistulas is significant. Even with the best available treatments, success rates don't exceed 60%. Without effective treatment, up to half of patients eventually need permanent stoma surgery (a surgically created opening to divert waste).

The procedure uses your body's own healing cells

The Lipogems® system processes a small amount of fat tissue from the patient's own body. This creates micro-fragmented adipose tissue containing pericytes (helper cells that support healing) and mesenchymal stromal cells (regenerative cells that can repair tissue). Unlike some cell therapies, this approach doesn't require growing cells in a laboratory or using enzymes to extract them. The fat is simply cleaned and broken into tiny pieces while preserving its natural healing properties.

Doctors performed the procedure in a day-surgery setting. They injected the processed fat tissue directly around and into the fistula tracks during a single session.

MRI scans confirmed what doctors saw clinically

Results weren't based only on physical examination. Every patient received a pelvic MRI scan at 24 weeks to verify the findings:

• Ten patients (67%) had complete healing confirmed both clinically and by MRI

• Four patients (27%) showed improvement but not complete closure

• One patient (6%) did not respond to treatment

The MRI confirmation is important because fistulas can appear closed on the surface while still having active disease deeper in the tissue.

No serious complications or side effects occurred

The study reported no relevant surgical complications or adverse events. This safety profile is particularly meaningful because these patients had already undergone multiple previous surgeries. The minimally invasive nature of the procedure means there's no risk of damaging the anal sphincter muscles, which can be a concern with other surgical approaches.

The researchers noted the treatment is affordable, minimally invasive, and can be done as an outpatient procedure.

What this means for your treatment decisions

This was a small pilot study without a comparison group, so it cannot prove the treatment works better than alternatives. However, the findings suggest micro-fragmented adipose tissue injection may be a reasonable "rescue therapy" option when standard treatments haven't worked.

The 67% complete remission rate in these difficult-to-treat patients compares favorably to other approaches. For example, another study found biological plugs achieved only 33% healing in similar patients.

If you have complex perianal fistulas that haven't responded to biologic medications and surgery, this research suggests fat tissue injection could be worth discussing with your gastroenterologist or colorectal surgeon. Larger studies with longer follow-up periods will help clarify how well this approach works over time.

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Source: Laureti et al., Inflammatory Bowel Diseases, 2019.