Lipografting and stromal vascular fractions of adipose tissue in the treatment of patients with radiation-induced rectovaginal fistulas

Objective : to analyze the efficacy of a newly developed method for the treatment of radiation-induced rectovaginal fistulas using autologous adipose tissue obtained by aspiration liposuction. Materials and methods . This retrospective study included 24 patients with radiation-induced rectovaginal fistulas that arose after chemoradiotherapy for malignant tumors of the female reproductive system. All patients underwent colostomy before treatment initiation. Study participants received 1 to 5 injections (mean number 3) of autologous adipose-derived regenerative cells. The main indication for the procedure was the presence of a fistula, diagnosed at least 6 months after the last course of radiation therapy. We evaluated time to fistula healing, results of elastometry, and presence of complications. Results. The mean total dose received by patients during their radiotherapy was 60 Gy; median time to initiation of fistula treatment was 15 months. Before the injection of adipose-derived regenerative cells, the mean fistula diameter was 2.50 + 0.46 cm, whereas after 3 months, it reduced to 1.35 + 0.47 cm and after 6 months, it was 1.12 + 0.47 cm. All patients had complete epithelialization of the defect. No cases of fistula recurrence were registered. Conclusion. We demonstrated high efficacy of a new reconstructive method for radiation-induced rectovaginal fistulas with autologous adipose tissue obtained by aspiration liposuction. Its effectiveness is confirmed by complete fistula closure and restoration of intestinal continuity in all study participants.