Efficacy of autologous fat graft injection in the treatment of anovaginal fistulas



Injection of autologous fat is an established method within plastic surgery for soft tissue augmentation. The aim of the present study was to determine whether transperineal fat graft injection could promote healing of anovaginal fistulas.


The procedures were performed at the University Hospital of North Norway, Tromsø, Norway, and at Aarhus University Hospital, Aarhus, Denmark, between May 2009 and September 2016. After abdominal liposuction, fat was injected around the fistula tract that was finally transected percutaneously with a sharp cannula and fat injected between the cut parts. The internal opening was closed with a suture. Patients had a minimum follow-up of 6 months after last fat graft injection.


Twenty-seven women underwent 48 procedures. The cause of fistula was obstetric (n = 9), abscess (n = 9), Crohn’s disease (n = 7), radiation for anal cancer (n = 1) and endoscopic surgery after radiation for rectal cancer (n = 1). The mean amount of injected fat was 73 ml (SD ± 20 ml), and operating time was 63 min (SD ± 21 min). At median follow-up of 20 months (range 6–87 months) after the last injection, fistulas were healed in 21 women (77%), in 8 women after just one procedure. Healing was achieved in 6 of 7 women (86%) with Crohn’s disease and in both women who had undergone radiation therapy. One woman developed an abscess and additional trans-sphincteric fistula 8 weeks after injection.


Fat graft injection for anovaginal fistulas is effective and safe.

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  1. 1.

    Das B, Snyder M (2016) Rectovaginal Fistulae. Clin Colon Rectal Surg 29(1):50–56. https://doi.org/10.1055/s-0035-1570393

    Article  PubMed  Google Scholar 

  2. 2.

    Ommer A, Herold A, Berg E, Furst A, Schiedeck T, Sailer M (2012) German S3-guideline: rectovaginal fistula. Ger Med Sci 10:Doc15. https://doi.org/10.3205/000166

    PubMed  PubMed Central  Google Scholar 

  3. 3.

    Prosst RL, Joos AK (2016) Short-term outcomes of a novel endoscopic clipping device for closure of the internal opening in 100 anorectal fistulas. Tech Coloproctol 20(11):753–758. https://doi.org/10.1007/s10151-016-1537-0

    CAS  Article  PubMed  Google Scholar 

  4. 4.

    Gaertner WB, Madoff RD, Spencer MP, Mellgren A, Goldberg SM, Lowry AC (2011) Results of combined medical and surgical treatment of recto-vaginal fistula in Crohn’s disease. Colorectal Dis 13(6):678–683. https://doi.org/10.1111/j.1463-1318.2010.02234.x

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Schwandner O, Fuerst A, Kunstreich K, Scherer R (2009) Innovative technique for the closure of rectovaginal fistula using Surgisis mesh. Tech Coloproctol 13(2):135–140. https://doi.org/10.1007/s10151-009-0470-x

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    Kniery KR, Johnson EK, Steele SR (2015) Operative considerations for rectovaginal fistulas. World J Gastrointest Surg 7(8):133–137. https://doi.org/10.4240/wjgs.v7.i8.133

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    Athanasiadis S, Yazigi R, Kohler A, Helmes C (2007) Recovery rates and functional results after repair for rectovaginal fistula in Crohn’s disease: a comparison of different techniques. Int J Colorectal Dis 22(9):1051–1060. https://doi.org/10.1007/s00384-007-0294-y

    Article  PubMed  Google Scholar 

  8. 8.

    Byrnes JN, Schmitt JJ, Faustich BM et al (2017) Outcomes of rectovaginal fistula repair. Female Pelvic Med Reconstr Surg 23(2):124–130. https://doi.org/10.1097/spv.0000000000000373

    Article  PubMed  Google Scholar 

  9. 9.

    Coleman SR (1995) Long-term survival of fat transplants: controlled demonstrations. Aesthetic Plast Surg 19(5):421–425

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Simonacci F, Bertozzi N, Grieco MP, Grignaffini E, Raposio E (2017) Procedure, applications, and outcomes of autologous fat grafting. Ann Med Surg (Lond) 20:49–60. https://doi.org/10.1016/j.amsu.2017.06.059

    Article  Google Scholar 

  11. 11.

    de Weerd L, Weum S, Norderval S (2015) Novel treatment for recalcitrant rectovaginal fistulas: fat injection. Int Urogynecol J 26(1):139–144. https://doi.org/10.1007/s00192-014-2497-4

    Article  PubMed  Google Scholar 

  12. 12.

    Xie Y, Zheng D, Li Q, Chen Y, Lei H, Pu LL (2010) The effect of centrifugation on viability of fat grafts: an evaluation with the glucose transport test. J Plast Reconstr Aesthet Surg 63(3):482–487. https://doi.org/10.1016/j.bjps.2008.11.056

    Article  PubMed  Google Scholar 

  13. 13.

    Ferraro GA, De Francesco F, Tirino V et al (2011) Effects of a new centrifugation method on adipose cell viability for autologous fat grafting. Aesthetic Plast Surg 35(3):341–348. https://doi.org/10.1007/s00266-010-9613-8

    Article  PubMed  Google Scholar 

  14. 14.

    Mazzola RF, Cantarella G, Torretta S, Sbarbati A, Lazzari L, Pignataro L (2011) Autologous fat injection to face and neck: from soft tissue augmentation to regenerative medicine. Acta Otorhinolaryngol Ital 31(2):59–69

    CAS  PubMed  PubMed Central  Google Scholar 

  15. 15.

    D’Aniello C, Cermola F, Patriarca EJ, Minchiotti G (2017) Vitamin C in stem cell biology: impact on extracellular matrix homeostasis and epigenetics. Stem Cells Int 2017:8936156. https://doi.org/10.1155/2017/8936156

    PubMed  PubMed Central  Google Scholar 

  16. 16.

    de Weerd L, Weum S, Norderval S (2013) Novel treatment of a rectourethroperineal fistula after perineal prostatectomy using autologous fat transplantation. Tech Coloproctol 17(2):235–238. https://doi.org/10.1007/s10151-012-0901-y

    Article  PubMed  Google Scholar 

  17. 17.

    Salgado AJ, Reis RL, Sousa NJ, Gimble JM (2010) Adipose tissue derived stem cells secretome: soluble factors and their roles in regenerative medicine. Curr Stem Cell Res Ther 5(2):103–110

    CAS  Article  PubMed  Google Scholar 

  18. 18.

    Kern S, Eichler H, Stoeve J, Kluter H, Bieback K (2006) Comparative analysis of mesenchymal stem cells from bone marrow, umbilical cord blood, or adipose tissue. Stem Cells 24(5):1294–1301. https://doi.org/10.1634/stemcells.2005-0342

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Garcia-Gomez I, Elvira G, Zapata AG et al (2010) Mesenchymal stem cells: biological properties and clinical applications. Expert Opin Biol Ther 10(10):1453–1468. https://doi.org/10.1517/14712598.2010.519333

    Article  PubMed  Google Scholar 

  20. 20.

    Garcia-Olmo D, Herreros D, Pascual I et al (2009) Expanded adipose-derived stem cells for the treatment of complex perianal fistula: a phase II clinical trial. Dis Colon Rectum 52(1):79–86. https://doi.org/10.1007/DCR.0b013e3181973487

    Article  PubMed  Google Scholar 

  21. 21.

    Molendijk I, Bonsing BA, Roelofs H et al (2015) Allogeneic bone marrow-derived mesenchymal stromal cells promote healing of refractory perianal fistulas in patients with Crohn’s disease. Gastroenterology 149(4):918–927.e916. https://doi.org/10.1053/j.gastro.2015.06.014

    Article  PubMed  Google Scholar 

  22. 22.

    Panes J, Garcia-Olmo D, Van Assche G, Collaborators ACSG (2016) Expanded allogeneic adipose-derived mesenchymal stem cells (Cx601) for complex perianal fistulas in Crohn’s disease: a phase 3 randomised, double-blind controlled trial. Lancet 388(10051):1281–1290. https://doi.org/10.1016/S0140-6736(16)31203-X

    Article  PubMed  Google Scholar 

  23. 23.

    Garcia-Arranz M, Herreros MD, Gonzalez-Gomez C et al (2016) Treatment of Crohn’s-related rectovaginal fistula with allogeneic expanded-adipose derived stem cells: a phase I-IIa clinical trial. Stem Cells Transl Med 5(11):1441–1446. https://doi.org/10.5966/sctm.2015-0356

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Joo JS, Weiss EG, Nogueras JJ, Wexner SD (1998) Endorectal advancement flap in perianal Crohn’s disease. Am Surg 64(2):147–150

    CAS  PubMed  Google Scholar 

  25. 25.

    Windsor ACJ, Lunniss PJ, Khan UA, Rumbles S, Williams K, Northover JMA (2000) Rectovaginal fistulae in Crohn’s disease: a management paradox. Colorectal Dis 2(3):154–158. https://doi.org/10.1046/j.1463-1318.2000.00155.x

    CAS  Article  PubMed  Google Scholar 

  26. 26.

    Ruffolo C, Penninckx F, Van Assche G et al (2009) Outcome of surgery for rectovaginal fistula due to Crohn’s disease. Br J Surg 96(10):1190–1195. https://doi.org/10.1002/bjs.6661

    CAS  Article  PubMed  Google Scholar 

  27. 27.

    Pinto RA, Peterson TV, Shawki S, Davila GW, Wexner SD (2010) Are there predictors of outcome following rectovaginal fistula repair? Dis Colon Rectum 53(9):1240–1247. https://doi.org/10.1007/DCR.0b013e3181e536cb

    Article  PubMed  Google Scholar 

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Correspondence to S. Norderval.

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The authors declare that they have no conflict of interest.

Ethical approval

Approval from local committees of research ethics was not needed according to Norwegian and Danish regulations.

Informed consent

The patients was thoroughly informed about the procedure and possible risk factors, and all patients gave their informed consent prior to surgery.

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Norderval, S., Lundby, L., Hougaard, H. et al. Efficacy of autologous fat graft injection in the treatment of anovaginal fistulas. Tech Coloproctol 22, 45–51 (2018). https://doi.org/10.1007/s10151-017-1739-0

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  • Anovaginal
  • Rectovaginal
  • Fistula
  • Crohn’s disease
  • Fat
  • Transplantation