Cell therapy in surgical treatment of fistulas. Preliminary results

• DOI: 10.5604/01.3001.0010.1019
• Publication Date: 2018-05-22T05:25:04Z
• Authors: Marcin Piejko; Michał Romaniszyn; Julia Borowczyk-M...; Justyna Drukała; Piotr Wałęga
• Keywords: Male; 0301 basic medicine; 0303 health sciences; Cell- and Tissue-Based Therapy; Rectovaginal Fistula; stem cell-based therapy; regenerative medicine; rectovaginal fistula; Middle Aged; 3. Good health; 03 medical and health sciences; recurrent fistula; anal fistula; Adipocytes; Humans; Female; Follow-Up Studies; Stem Cell Transplantation

Risk of recurrence after surgical treatment of a recurrent fistula is up to 50%. It has be known that more aggressive surgical treatment is associated with a high risk of anal sphincter damage and leads to incontinence. Several studies have been designed to elaborate minimally invasive treatment of rectovaginal and anal fistulas. The properties of Adipose-derived Stem Cells (ASC) significantly enhance a natural healing potency. Here, we present our experience with combined surgical and cell therapy in the treatment of fistulas. Materials and Methods: Four patients were enrolled in our study after unsuccessful treatments in the past – patients 1-3 with rectovaginal fistulas including two women after graciloplasty, and patient 4 - a male with complex perianal fistula. Adipose tissue was obtained from subcutaneous tissue. ASCs were isolated, cultured up to 10+/-2 mln cells and injected into the walls of fistulas. Follow-up physical examination and anoscopy were performed at 1, 4, 8, and 12 weeks, 6 and 12 months after implantation. Results: Up to 8 weeks after ASC implantation, symptoms of fistulas’ tracts disappeared. At 8 weeks, in patients 1-3, communication between vaginal and rectal openings was closed and at 12-16 w. intestinal continuity was restored in patient 3 and 4. After a 6-month follow-up, the fistula tract of patient 4 was closed. Up to 12 m. after ASC implantation no recurrences or adverse events were observed. Conclusion: ASCs combined with surgical pre-treated fistula tracts were used in four patients. All of them were healed. This encouraging result needs further trials to evaluate the clinical efficiency and the cost-effectiveness ratio.