Recurrent anal fistulae: Limited surgery supported by stem cells
Entity
UAM. Departamento de Cirugía; Instituto de Investigación Sanitaria Fundación Jiménez Díaz (IIS-FJD)Publisher
Baishideng Publishing Group Inc.Date
2015-01-01Citation
10.3748/wjg.v21.i11.3330
World Journal of Gastroenterology 21.11 (2015): 3330-3336
ISSN
1007-9327 (print); 2219-2840 (on line)DOI
10.3748/wjg.v21.i11.3330Editor's Version
http://dx.doi.org/10.3748/wjg.v21.i11.3330Subjects
Adipose-derived stem cells; Cell therapy; Compassionate use; Crohn’s disease; Fistula-in-ano; MedicinaRights
© 2015 Baishideng Publishing Group Inc.Abstract
AIM: To study the results of stem-cell therapy under a
Compassionate-use Program for patients with recurrent
anal fistulae.
METHODS: Under controlled circumstances, and approved
by European and Spanish laws, a Compassionate-use
Program allows the use of stem-cell therapy for patients
with very complex anal fistulae. Candidates had
previously undergone multiple surgical interventions
that had failed to resolve the fistulae, and presented
symptomatic recurrence. The intervention consisted of
limited surgery (with closure of the internal opening),
followed by local implant of stem cells in the fistula-
tract wall. Autologous expanded adipose-derived stem
cells were the main cell type selected for implant. The
first evaluation was performed on the 8th postoperative
week; outcome was classified as response or partial
response. Evaluation one year after the intervention
confirmed if complete healing of the fistula was
achieved.
RESULTS: Ten patients (8 male) with highly recurrent
and complex fistulae were treated (mean age: 49
years, range: 28-76 years). Seven cases were non-
Crohn’s fistulae, and three were Crohn’s-associated
fistulae. Previous surgical attempts ranged from 3
to 12. Two patients presented with preoperative
incontinence (Wexner scores of 12 and 13 points).
After the intervention, six patients showed clinical
response on the 8th postoperative week, with a
complete cessation of suppuration from the fistula.
Three patients presented a partial response, with
an evident decrease in suppuration. A year later,
six patients (60%) remained healed, with complete
reepithelization of the external opening. Postoperative
Wexner Scores were 0 in six cases. The two patients
with previous incontinence improved their scores from
12 to 8 points and from 13 to 5 points. No adverse
reactions or complications related to stem-cell therapy
were reported during the study period.
CONCLUSION: Stem cells are safe and useful for
treating anal fistulae. Healing can be achieved in severe
cases, sparing fecal incontinence risk, and improving
previous scoring
Files in this item
Google Scholar:García Olmo, Damián
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Guadalajara Labajo, Héctor
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Rubio-Pérez, Inés
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Herreros, María Dolores
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Quintana, Paloma de la
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García Arranz, Mariano Andrés
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