Abstract Background Perianal fistulizing Crohn’s Disease (PFCD) is associated with significant therapeutic challenges, poorer prognosis and reduced quality of life1. This aggressive phenotype is observed in 41.3% of Crohn’s Disease (CD) patients in our service2. Refractoriness and frequent reoperations highlight the need for more effective treatment alternatives3. Nanofat-based autologous stem cell therapy has shown promising results and high cost-effectiveness, an essential advantage in the healthcare systems of developing countries3,4. This study aimed to assess clinical healing at six months, characterized by the complete closure of all treated external openings (EO) and tracts, with no evidence of drainage, even upon external pressure. Methods Patients aged 18 years or older with PFCD refractory to standard medical therapy, without clinical, laboratory, or endoscopic rectal activity from a Brazilian tertiary public hospital were included. Prior to the definitive procedure, all patients underwent examination under anesthesia (EUA), fistula tract curettage, and seton placement. The surgical protocol consisted of seton removal, irrigation and curettage of the fistulous tracts, excision of the EO, closure of the internal openings (IO) using interrupted 3-0 absorbable sutures, followed by the application of nanofat (≈ 40 mL) at the IO region and into the tissue surrounding the fistulous tract. For the nanofat preparation approximately 100 mL of subcutaneous adipose tissue was harvested from abdominal or medial thigh region. The aspirate was decanted to obtain microfragmented fat (microfat), which was subsequently emulsified and filtered to obtain the nanofat4. The study was approved by the institutional ethics committee. Statistical analyses were performed using SPSS version 21.0 (SPSS, Chicago, IL, USA). Results Ten patients were submitted to the technique between April 2024 and May 2025, with a median age of 26,5 years and a median BMI of 23,7 kg/m². At six months, 90% of the patients met the criteria for clinical healing. The PDAI decreased from a median of 5.5 to 0 points. Over a median of 14,5 months (from 6 to 19 months) of follow-up, no recurrences and relevant adverse events related to liposuction or nanofat application were observed. Conclusion Autologous nanofat injection was a safe and effective surgical technique for the treatment of PFCD. Given its low cost and efficacy, this technique may represent an affordable treatment option, particularly in developing countries. References: 1. Lightner AL, Irving PM, Lord GM, Betancourt A. Stem Cells and Stem Cell-Derived Factors for the Treatment of Inflammatory Bowel Disease with a Particular Focus on Perianal Fistulizing Disease: A Minireview on Future Perspectives. BioDrugs. 2024;38(4):527-539. doi:10.1007/s40259-024-00661-6. 2. De Codes LMG, De Jesus ACC, De Codes JJG, et al. Anorectal Function and Clinical Characteristics Associated with Faecal Incontinence in Patients with Crohn’s Disease. Journal of Crohn’s and Colitis. Oxford University Press; 2023. p. 1252–61. 3. De Gregorio M, Tiang T, Lee T, et al. Autologous fat graft injections for the treatment of perianal fistulas in Crohn’s disease: a systematic review and single-arm meta-analysis. ANZ J Surg. 2023;93(5):1162-1168. doi:10.1111/ans.18231. 4. Carvalho AL, Codes, LMG, Melo, AFM et al. Autologous nanofragmented lipoinjection (nanofat) for the treatment of perianal fistulizing Crohn’s disease (PFCD). Journal of Coloproctology 2025; 45. e1-e4. doi:10.1055/s-0045-1809669. Conflict of interest: De Carvalho, Alexandre: I have received fees for lectures and support for conferences and courses paid for by Janssen. Dr. Góes De Codes, Lina Maria: No conflict of interest De Carvalho, Cauã: No conflict of interest Zanvettor, Mateus: No conflict of interest Freire, Adriele: No conflict of interest Kotze, Paulo Gustavo: Grant: Pfizer, Takeda Personal Fees: Abbvie, Johnson & Johnson, Ferring, Pfizer, Takeda, Celltrion Other: Abbvie, Janssen, Ferring, Pfizer, Takeda Martins Netto, Eduardo: No conflict of interest Oliveira Santana Silva, Genoile: Honoraria - Abbvie, Johnson & Johnson, Ferring, Takeda. Research - Abivax, Takeda, Johnson & Johnson, Roche, Sanofi, Polpharma. Advisory board - Abbvie, Johnson & Johnson, MSD.
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