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A Stem cell is a special human cell that is able to develop into many different cell types in the body. It has three important features: differentiation, trophic factors secretion and immunomodulation. With these characteristics they are able to heal damaged tissue, modulate excessive inflammation and, in some cases, create new tissue. There are two types of stem cells, embryologic and adult. We only use adult mesenchymal stem cells in our clinical practice and we obtain them from the adipose tissue.

We can use adipose derived adult stem cells to improve the healing and modulate the inflammation. Therefore, we are using them for any wound that is not healing properly. We are colorectal surgeons. An enteric or perianal fistula is a perfect example of a tissue which is not healing satisfactorily. We use stem cells to treat perianal, rectovaginal or enteric fistula and also to improve the healing of any chronic wound. The stem cell therapy is also indicated and successful in cryptoglandular perianal fistula which is the one not related to Crohn´s disease.

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Perianal and rectovaginal suppose an important impairment of the quality of life in these patients. To reach the fistula healing is a dramatic change in their life. The first time we used adipose derived stem cells was in 2002; it was the first person receiving such treatment in the world. This case was a 33 y/o woman with Crohn´s disease of 11 years of evolution. She suffered severe perianal disease, needing several surgeries to drain abscesses and seton placement, as well as several complex surgeries for perianal fistula, not always successful. She developed a rectovaginal fistula. We performed a liposuction, isolated at the lab her mesenchymal stem cells and cultured them. Later we performed a vaginal flap and injected stem cells additionally. The fistula healed several weeks later. Since then, we have treated with stem cell therapy more than 500 patients over the last 20 years, reaching a healing rate of 70% in both cryptoglandular or Crohn´s related perianal fistulas.

When we are going to treat a perianal fistula first of all we need to rule out any abscesses in the area. If an abscess is present will plan an incision and drainage procedure 2 weeks before the stem cells are implanted. The day of surgery, we take the patient to the operation room. We identify the internal hole and the fistula tracts. We perform a deep curettage of the area and we suture the internal orifice. The next step is the injection of the stem cells in the tissue. Half of the doses is distributed in the internal hole and the rest of the cells is injected in the tissue surrounding the fistula tracts.