A Dermatologist's Technique (Injection of Emulsified Adipose Tissue Stromal Vascular Fraction): Can it be Repurposed by Surgeons for the Treatment of Digestive Fistulas?

Background: Digestive fistulas, including esophageal and perianal types, remain a major therapeutic challenge due to their complex anatomy and resistance to conventional treatments. A novel approach adapted from dermatology—endoscopic injection of emulsified adipose tissue stromal vascular fraction (tSVFem)—has shown promise in regenerative medicine. Objective: This article explores the potential of repurposing a dermatological technique involving autologous tSVFem injections for the minimally invasive treatment of digestive fistulas. Methods: Recent clinical studies and case series were reviewed to assess the efficacy, safety, and mechanism of action of tSVFem in the treatment of gastrointestinal fistulas. The technique involves mechanical emulsification of adipose tissue to isolate SVF, followed by direct endoscopic injection into the fistulous tract. Results: In a case series of esophageal fistulas, complete closure was achieved in all patients within one week following tSVFem injection, with no recurrence over eight months. In patients with Crohn's-related perianal fistulas, clinical healing occurred in up to 83% of cases, with durable outcomes observed at three-year follow-up. The regenerative effect is attributed to the anti-inflammatory, angiogenic, and extracellular matrix remodeling properties of the SVF cellular components. Conclusion: The adaptation of tSVFem injection from dermatology to visceral surgery represents a promising, minimally invasive therapeutic alternative for complex digestive fistulas. Further randomized controlled trials are warranted to validate these early findings and to standardize the procedure for broader clinical use.