Cell therapy in surgical treatment of fistulas. Preliminary results
Male
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
DOI:
10.5604/01.3001.0010.1019
Publication Date:
2018-05-22T05:25:04Z
AUTHORS (5)
ABSTRACT
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.
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