Recovery of Function in Anal Incontinence After Micro-Fragmented Fat Graft (Lipogems®) Injection: Two Years Follow Up of the First 5 Cases

ABSTRACT Anal incontinence is common and significantly diminishes quality of life. This work aims to investigate the therapeutical potential of regenerative lipofilling by lipoaspirated fat, washed and reduced in size by the new device Lipogems®, in patients affected by chronic fecal incontinence. 5 patients with fecal incontinence due to obstetric injury and anorectal-pelvic surgery were followed up for 24 months after grafting of an average of 90 cc of aspirated and microfragmented fat (Lipogems®) in the external, internal anal sphincters and around pudendal nerves. Wexner-Incontinence-Score and Fecal-Incontinence-Quality-of-Life-Scale were used before and after treatment together with digital exploration, proctoscopy, endoanal ultrasound and anorectal manometry. All patients observed an improvement both short and long term. The Wexner-IncontinenceScore improved from a preoperative mean of 14.0 to 3.4 at 3 months after treatment and remained stable up to 24 months. Anorectal manometry has reported over time significant improvements of pressure both at rest and in squeeze. Ultrasonography showed reabsorption of Lipogems tissue at 6 months and clear muscle repair at 12 and 24 months. Our preliminary results suggest that this regenerative lipofilling can improve symptoms of fecal incontinence due to muscular and neural local trauma. Further studies are necessary to clarify the underlying mechanism, but a paracrine action of the mesenchymal stem cells contained in the fat tissue or in the purified fat cells themselves is postulated, as at 6-12 months when ecography of transplanted fat shows that the injected material disappeared while the beneficial clinical effects continue to be present and improve over time.