Novosti
Khirurgii

 This journal is
indexed in Scopus
journal cover
android icon Android Applicaion

Year 2012 Vol. 20 No 6

GENERAL AND SPECIAL SURGERY

S.V. SHAKHRAI, YU.M. GAIN, M.YU. GAIN

EXPERIMENTAL JUSTIFICATION AND FIRST CLINICAL EXPERIENCE OF TRANSPLANTATION OF CULTURE OF AUTOLOGICAL ADIPOSE TISSUE MESENCHYMAL STEM CELLS IN COMPLEX SURGICAL TREATMENT OF EXTRA- AND TRANS-SPHINCTER RECTUM FISTULAS

SEE “Belarusian Medical Academy of post-graduate education”, Minsk, The Republic of Belarus

Objectives. To develop the technology of minimally invasive treatment of trans- and extra-sphincter rectum fistulas with the use of semi-conductor laser radiation and transplantation of autological adipose tissue mesenchymal stem cells.
Methods. The way of chronic paraproctitis modeling has been developed in experiment. Morphological changes of pararectal tissue at complex use of the laser radiation with the length of a wave 1056 nanometers and autological adipose tissue mesenchymal stem cells to treat rectum fistulas have been studied. The worked out minimally invasive method of surgical treatment of high rectum fistulas has been applied in 10 patients.
Results. The designed technology includes the pretransplantation stage (biological material intake, extraction, cultivating, proliferation, differentiation of the autological adipose tissue mesenchymal stem cells in the fibroblast direction with the culture selection of stem cells up to 500 thousands units in 1 ml), and the surgical stage with decontamination of the fistulous channel by the laser radiation with wave length 1560 nm, with suturing the internal opening of rectum fistula and transplantation of mesenchymal stem cells culture from adipose tissue in the fistula channel and parafistula space.
In experiment the results have been obtained testifying to high efficacy of the suggested technology with quick fibrous replacement of the fistula lumen and reduction of the inflammatory process in this zone and in parafistula tissues caused by autological mesenchymal stem cells differentiation in the cellular elements of the connective-fibrous layer, their production of biologically active factors that induce regeneration and promote the accelerated organization of the extracellular matrix.
It has been established that technology application in patients with high rectum fistulas of autotransplantation of adipose tissue mesenchymal stem cells differentiated in the fibroblast direction is an effective complex method of their treatment
Conclusions. The first experience of clinical application of the developed technology allows saying that its practical use promotes efficacy increase of surgical treatment as well as expansion of the application sphere of cellular technologies in practical public health services.

Keywords: chronic paraproctitis, rectum fistulas, adipose tissue mesenchymal stem cells, cellular transplantation
p. 60 – 69 of the original issue
References
  1. Bleier JIS, Moloo H. Current management of cryptoglandular fistula-in-ano. World J Gastroenterol. 2011;17(28):3286–91.
  2. Dudukgian H, Abcarian H. Why do we have so much trouble treating anal fistula? World J Gastroenterol. 2011;17(28):3292–96.
  3. Vorob'ev GI, red. Osnovy koloproktologii [Fundamentals of Coloproctology]. Moscow, RF; 2006. p. 135–52.
  4. Atkin GK, Martins J, Tozer P, Ranchod P, Phillips RK. For many high anal fistulas, lay open is still a good option. Tech Coloproctol. 2011 Jun;15(2):143–50.
  5. El-Tawil A. Management of fistula-in-ano: an introduction. World J Gastroenterol. 2011 Jul 28;17(28):3271.
  6. Malik AI, Nelson RL Surgical management of anal fistulae: a systematic review. Colorectal Dis. 2008 Jun;10(5):420–30.
  7. Lindsey I, Smilgin-Humphreys MM, Cunningham C, Mortensen NJ, George BD. A randomized, controlled trial of fibrin glue vs. conventional treatment for anal fistula. Dis Colon Rectum. 2002 Dec;45(12):1608–15.
  8. Jacob TJ, Perakath B, Keighley MR. Surgical intervention for anorectal fistula. Cochrane Database Syst Rev. 2010 May 12;(5):CD006319.
  9. Abbas MA, Jackson CH, Haigh PI. Predictors of outcome for anal fistula surgery. Arch Surg. 2011;146(9):1011–16.
  10. Buchanan GN, Bartram CI, Phillips RK, Gould SW, Halligan S, Rockall TA, Sibbons P, Cohen RG. Efficacy of fibrin sealant in the management of complex anal fistula: a prospective trial. Dis Colon Rectum. 2003 Sep;46(9):1167–74.
  11. Christoforidis D, Etzioni DA, Goldberg SM, Madoff RD, Mellgren A. Treatment of complex anal fistulas with the collagen fistula plug. Dis Colon Rectum. 2008 Oct;51(10):1482–7.
  12. Chung W, Kazemi P, Ko D, Sun C, Brown CJ, Raval M, Phang T. Anal fistula plug and fibrin glue versus conventional treatment in repair of complex anal fistulas. Am J Surg. 2009 May;197(5):604–8.
  13. de la Portilla F, Rada R, Jimenez-Rodriguez R, Diaz-Pavon JM, Sanchez-Gil JM. Evaluation of a new synthetic plug in the treatment of anal fistulas: results of a pilot study. Dis Colon Rectum. 2011 Nov;54(11):1419–22.
  14. Christoforidis D, Pieh MC, Madoff RD, Mellgren AF. Treatment of transsphincteric anal fistulas by endorectal advancement flap or collagen fistula plug: a comparative study. Dis Colon Rectum. 2009 Jan;52(1):18–22.
  15. Johnson EK, Gaw JU, Armstrong DN. Efficacy of anal fistula plug vs. fibrin glue in closure of anorectal fistulas. Dis Colon Rectum. 2006 Mar;49(3):371–76.
  16. Ky AJ, Sylla P, Steinhagen R, Steinhagen E, Khaitov S, Ly EK. Collagen fistula plug for the treatment of anal fistulas. Dis Colon Rectum. 2008 Jun;51(6):838–43.
  17. Lenisa L, Espin-Basany E, Rusconi A, Mascheroni L, Escoll-Rufino J, Lozoya-Trujillo R, Vallribera-Valls F, Megevand J. Anal fistula plug is a valid alternative option for the treatment of complex anal fistula in the long term. Int J Colorectal Dis. 2010 Dec;25(12):1487–93.
  18. Safar B, Jobanputra S, Sands D, Weiss EG, Nogueras JJ, Wexner SD. Anal fistula plug: initial experience and outcomes. Dis Colon Rectum. 2009 Feb;52(2):248–52.
Address for correspondence:
220013, Respublika Belarus, G. Minsk, ul. P. Brovki, d. 3, korp. 3, GUO «Belorusskaya meditsinskaya akademiya poslediplomnogo obrazovaniya», kafedra neotlozhnoy khirurgii s kursom ambulatornoy khirurgii,
e-mail: s.shakhrai@mail.ru,
Shahray Sergey Vladimirovich
Information about the authors:
Shakhrai S.V. Candidate of medical sciences, associate professor of the emergency surgery chair of SEE “Belarusian Medical Academy of post-graduate education”.
Gain U.M. Doctor of medical sciences, professor, Vice-rector on scientific research work, professor of the emergency surgery chair of SEE “Belarusian Medical Academy of post-graduate education”.
Gain M.Y. Post-graduate student of the emergency surgery chair of SEE “Belarusian Medical Academy of post-graduate education”.
Contacts | ©Vitebsk State Medical University, 2007-2023