Autologous Fat Grafting: an Emerging Treatment Option for Complex Anal Fistulas

Area of Science:

• Colorectal Surgery
• Plastic Surgery
• Regenerative Medicine

Background:

• Autologous fat grafting (AFG) demonstrates potential for complex wound healing with favorable safety and efficacy.
• Complex anorectal fistulas present a significant clinical challenge requiring innovative treatment strategies.

Purpose of the Study:

• To evaluate the effectiveness and safety of autologous fat grafting (AFG) in managing complex anorectal fistulas.
• To assess outcomes including symptom improvement, fistula closure, recurrence, and complications.

Main Methods:

• Retrospective review of a prospectively maintained, IRB-approved database of patients undergoing AFG for anorectal fistulas.
• Analysis of symptom improvement, clinical closure rates, recurrence, complications, and fecal incontinence.
• Use of the Perianal Disease Activity Index (PDAI) for patients receiving combination therapy.

Main Results:

• Out of 52 patients (81 procedures), 80.4% experienced symptom improvement and 64.4% achieved clinical fistula closure.
• The recurrence rate was 40.4%, with a complication rate of 15.4% (abscesses, bleeding).
• No significant outcome differences were observed based on treatment variations (single vs. multiple grafts, Crohn's vs. non-Crohn's, fat preparation, diversion).

Conclusions:

• Autologous fat grafting (AFG) is a versatile, safe, and affordable option for complex anorectal fistulas.
• AFG can be combined with other therapies and does not preclude future treatments upon recurrence.
• This approach offers a promising solution for challenging fistula cases.