Treatment of Perianal Fistulas in Crohn's Disease With Autologous Microfragmented Adipose Tissue With the Lipogems® System

Crohn's disease is a chronic inflammatory disease of unknown etiology, probably multifactorial, which can affect the entire digestive tract but especially the terminal ileum. Its incidence is increasing exponentially, resulting in a growing care commitment and an increasingly onerous economic burden for the NHS.

In 25% - 80% of patients with m. Crohn's disease there is an involvement of the perianal tissues due to particularly disabling symptoms such as pain, chronic mucopurulent secretions, recurrent acute septic episodes which, in over a third of cases, result in complex anal and ano-vaginal fistulas with the need for hospitalization multiple and significant impairment of the quality of socio-relational and working life.

The treatments currently available for perianal Crohn's are mainly based on the use of biological drugs known both for their high cost and for their important side effects, but 37% of patients present recurrence or persistence of the disease with the need to resort to surgery . In about 90% of cases, the surgery is repeated more than once, resulting in a significantly increased risk of faecal incontinence.

Sometimes a stoma and proctectomy may be necessary. Göttgens KW et al. highlight how, in the last twenty years, the risk of developing a perianal fistula has remained substantially stable, as well as its recurrence rate, underlining the need to improve treatment strategies.

The COVID-19 pandemic has further complicated the clinical management of patients with m. Crohn's disease both due to the need to limit their mobility and access to healthcare settings and due to the fear that immunosuppressive and immunomodulatory therapies could expose them to a greater risk of infection and complications. Although an increase in the incidence of SARS COVID-19 infection is not currently demonstrated in this subpopulation of patients, it could, however, be more vulnerable to COVID-19. In fact, it has been seen how the SARS-CoV 2 virus enters the cells by binding to the ACE2 receptors which are overexpressed at the level of the inflamed intestinal epithelium and constitute a potential entry route for the virus into the human body. Furthermore, a recent international survey has shown that it is common practice to suspend biological therapy in patients with m. Crohn's disease infected with SARS-CoV 2.