Use of microfragmented autologous adipose tissue (LIPOGEMS®) as a sphincter-saving therapy for complex anal fistulas: a single-center retrospective study.

Early human evidence such as case series or small samples is exploring possible benefits.

• Level A · Stronger Clinical Evidence
• Level B · Emerging clinical evidence with positive signals
• Level C · Early human research exploring benefits
• Level D · Scientific groundwork from lab and animal studies
• Emerging · Emerging topic under active research

Abstract (original English)

Complex anal fistulas remain a therapeutic challenge due to high recurrence rates and the risk of incontinence associated with conventional treatments. Microfragmented autologous adipose tissue has emerged as a sphincter-sparing option with potential regenerative and anti-inflammatory properties. This study aimed to evaluate the safety and efficacy of its injection into the fistula tract combined with closure of the internal opening. A single-center, retrospective, observational study was conducted between June 2019 and May 2025. All patients with complex anal fistulas treated with microfragmented adipose tissue processed with LIPOGEMS® system were included. Demographic data, fistula characteristics, surgical history, perioperative variables, postoperative morbidity, healing rate, and hospital stay were analyzed. Follow-up visits were performed weekly in the first month, and at 3, 6 and 12 months thereafter. A total of 28 patients with complex fistula were included. Mean patient age was 51.2 years (SD: 15.3), with predominance of males (69.7%). Most fistulas were medium or high transsphincteric (85.7%) and the main location was posterior (57.1%). 75% of patients had undergone previous curative-intent procedures. Median operative time was 71 minutes, and median processed adipose volume was 14 ml. Two postoperative complications were recorded (one abdominal hematoma-CD I and one

Evidence level

Early human evidence such as case series or small samples is exploring possible benefits.

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