Treating Complex Recurrent Anal Fistulas with Lipogems®
Marco De Monti, Giovanni Cestaro, Luca Regusci, Fabrizio Fasolini, Ken Galetti · International Journal of Regenerative Medicine · 2022
Two-thirds of patients healed after multiple failed surgeries
This 2022 case series from Switzerland and Italy examined a combined approach for treating complex recurrent anal fistulas—abnormal tunnels between the rectum and skin that had not healed despite previous operations. The researchers treated three patients using video-assisted fistula surgery (VAAFT) combined with Lipogems® micro-fragmented fat tissue. All three patients had undergone multiple prior surgeries over periods ranging from one to 15 years without success. Two of the three patients achieved complete healing with no symptoms over one to two years of follow-up.
Why repeated surgery creates greater challenges
Anal fistulas affect about nine in every 100,000 people yearly in Western countries. These tunnels can form after infections, abscesses, or conditions like Crohn's disease. When fistulas return after treatment, surgeons face a difficult situation. Each additional operation increases the risk of damaging the sphincter muscles that control bowel function. This can lead to incontinence—a life-altering complication. Finding treatments that heal fistulas without repeated cutting becomes essential for these complex cases.
Video guidance reveals hidden fistula pathways
The procedure begins with video-assisted anal fistula treatment (VAAFT). A tiny camera enters the fistula's external opening. This allows surgeons to see the entire tunnel, including any hidden branches or pockets of infection. The video guidance then directs a small electrode to destroy the diseased tissue throughout the pathway. This thorough mapping and cleaning prepare the fistula for healing. The internal opening is then carefully closed with stitches.
Fat tissue provides both filling and healing support
After preparing the fistula, surgeons harvest fat tissue from the patient's abdomen, hips, or thighs. The Lipogems® device processes this fat into micro-fragmented adipose tissue (MFAT). This specially prepared material contains pericytes and mesenchymal stem cells—natural healing cells that support tissue repair. The processed fat is then injected into the cleaned fistula tract and surrounding tissues. It serves two purposes: filling the space to prevent the tunnel from reopening, and promoting genuine tissue regeneration through its healing cells.
One failure linked to patient factors, not the technique
Of the three patients treated, one did not heal. The researchers attributed this failure to poor patient compliance and personal habits that interfered with recovery. This patient was subsequently lost to follow-up. The other two patients experienced complete symptom resolution. Their results held steady over follow-up periods of one to two years. While three cases represent a small number, these outcomes suggest the combined approach may offer hope for patients who have exhausted other options.
A promising option when standard treatments fail
The researchers concluded that combining video-assisted surgery with Lipogems® fat injections offers a valid, safe, and feasible option for difficult anal fistulas. The procedure leverages the immunomodulatory properties of mesenchymal cells—meaning these cells help regulate inflammation and support healing. This same property makes the technique useful in treating fistulas associated with Crohn's disease. For patients facing the prospect of yet another traditional surgery with increasing incontinence risk, this regenerative approach represents a sphincter-sparing alternative worth discussing with their surgical team.
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Source: De Monti et al., International Journal of Regenerative Medicine, 2022.
Original Publication
Regenerative and Endoscopic Treatment of Complex Recurrent Fistula in Ano: When Technology Supports Clinical Treatment
Marco De Monti, Giovanni Cestaro, Luca Regusci, Fabrizio Fasolini, Ken Galetti · International Journal of Regenerative Medicine · 2022
Recurrent anal fistulas present a challenge to surgeons due to the high risk of post-operative incontinence caused by repeated surgery. The correct identification of the anatomy of the main and secondary fistula tracts and the individuation of abscess cavities are fundamental for correct treatment. Intraoperative endoscopic evaluation and the complete destruction of the fistula pathway can be achieved through video-assisted anal fistula treatment (VAAFT). Furthermore, the injection of human autologous Microfractured Adipose Tissue (MFAT) processed by a Lipogems® device can be used as both a bulking agent and a regenerative technique. A combined approach of VAAFT plus Microfractured Adipose Tissue Graft (MFAT) is proposed in order to treat recurrent and complex fistula in ano. Three cases treated with a combination of VAAFT and MFAT grafts are described. All cases had undergone multiple interventions at the perianal level over a period ranging from 1 to 15 years. One case certainly failed due to poor patient compliance, but in the remaining two cases, the patients made a complete recovery with the disappearance of symptoms over a follow-up period of one to two years. The combination of video-assisted anal fistula treatment and injection of human autologous microfractured adipose tissue may be a valid, safe and feasible therapeutic option. MFAT injections are more effective in promoting tissue regeneration than simply 'filling' the fistula tract and are common practice also in the treatment of Crohn's Disease due to the immunomodulatory power of mesenchymal cells.