Autologous Fat Injection for Pouch-Related Fistulae: UEG Journal — December 2025

Introduction

Ileal pouch–anal anastomosis (IPAA) is the standard restorative surgery for patients with ulcerative colitis (UC) or familial adenomatous polyposis (FAP) after colectomy. Although IPAA significantly improves the quality of life, long-term complications remain common. One of the most challenging complications is pouch-related fistulae (PRF), occurring in approximately 5–10% of patients. These fistulae can cause persistent discharge, infections, and may ultimately lead to pouch failure and permanent ileostomy.

Management of PRF is difficult, and no consensus exists regarding optimal therapy. Traditional surgical approaches often risk sphincter damage and recurrence. Recently, regenerative strategies such as mesenchymal stem cell therapy have shown promise. Autologous adipose tissue injection (AATI), which contains stromal vascular fraction and stem-cell–like components, offers a simpler and minimally invasive alternative.

Summary

This prospective cohort study evaluated autologous adipose tissue injection (AATI) for the treatment of pouch-related fistulae in patients with IPAA.

Participants: 21 patients with 29 PRF

Follow-up: Median 16 months

Key findings:

48% fistula healing after a single injection

69% healing after repeated injections

14% additional patients showed partial improvement with reduced fistula secretion

Minimal complications and good procedural tolerance

Healing varied by fistula type:

Anastomosis-cutaneous fistulae: highest success (100%)

Pouch-vaginal fistulae: lowest response rates

Clinical Implications

Autologous adipose tissue injection appears to be a safe, minimally invasive, and sphincter-preserving treatment for pouch-related fistulae. The encouraging healing rates suggest that AATI may represent a promising regenerative approach, although larger controlled studies are required before widespread adoption.