title: Adipose Tissue-Derived Regenerative Cell-Enhanced Lipofilling for Treatment of Cryptoglandular Fistulae-in-Ano: The ALFA Technique.
abstract: BACKGROUND
  The treatment of complex fistulae-in-ano is challenging and often includes a number of operations due to high rates of recurrence. Recently, techniques using in vitro expanded adipose tissue-derived stem cells have been described. We describe a novel treatment for cryptoglandular fistulae used in 7 patients, using a combination of surgical closure of the internal opening and real-time autologous adipose tissue-derived regenerative cells (ADRC)-enhanced lipofilling, without need for in vitro expansion.
  
  
  METHODS
  Following exclusion of active perianal sepsis, patients underwent a standard tumescent liposuction procedure, harvesting ~300 to 400 mL of raw lipoaspirate. The lipoaspirate was prepared in real time, using the Celution 800/CRS system to obtain the stromal vascular fraction containing ADRCs. After excision of the fistula tract and closure of the internal orifice, fresh ADRC-enhanced lipoaspirate was injected into and around the fistula tract.
  
  
  RESULTS
  At 6-months' follow-up, 5 of 7 (71.4%) patients showed clinical signs of fistula closure; one of these patients had a recurrence at 10 months due to sepsis. The remaining 4 patients (57.1%) all had complete fistula closure at a median of 46 months' follow-up. There were no adverse events associated with the technique, and no new incontinence.
  
  
  CONCLUSIONS
  Treatment of cryptoglandular fistulae-in-ano with ADRC-enhanced lipofilling appears feasible and safe, and may add to the range of procedures that can be used to treat this difficult problem.
authors.affiliation: North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, Stockton-on-Tees, UK dwborowski@aol.com.
authors.forename: David W
authors.initials: DW
authors.lastname: Borowski
authors.affiliation: North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, Stockton-on-Tees, UK.
authors.forename: Talvinder S
authors.initials: TS
authors.lastname: Gill
authors.affiliation: North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, Stockton-on-Tees, UK.
authors.forename: Anil K
authors.initials: AK
authors.lastname: Agarwal
authors.affiliation: North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, Stockton-on-Tees, UK.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Tabaqchali
authors.affiliation: North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, Stockton-on-Tees, UK.
authors.forename: Dharmendra K
authors.initials: DK
authors.lastname: Garg
authors.affiliation: North Tees and Hartlepool NHS Foundation Trust, University Hospital of North Tees, Stockton-on-Tees, UK.
authors.forename: Pud
authors.initials: P
authors.lastname: Bhaskar
mesh_terms: D000273:Adipose Tissue / Q000166:cytology* / Q000637:transplantation*; D000328:Adult; D001003:Anal Canal / Q000601:surgery; D017690:Cell Transplantation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D015187:Lipectomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012003:Rectal Fistula / Q000601:surgery*; D044968:Regenerative Medicine; D013524:Surgical Flaps / Q000601:surgery; D023822:Tissue Engineering / Q000379:methods*
keywords: adipose tissue–derived regenerative cells; colorectal surgery; fistula-in-ano; lipofilling; stem cells; surgery; tissue engineering