{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:52:56Z","timestamp":1787755976091,"version":"build-2784847793"},"reference-count":11,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2020,10,13]],"date-time":"2020-10-13T00:00:00Z","timestamp":1602547200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Aim of the study: To assess the efficacy of a novel technique (echo-assisted intersphincteric autologous microfragmented adipose tissue injection, also called \u201canal-lipofilling\u201d) in the management of non-responsive fecal incontinence in children born with anorectal malformations (ARMs). Methods: Following ethical committee approval (CHPED-MAR-18-02), anal-lipofilling was proposed to patients with fecal incontinence not responsive to medications or bowel management (bowel enema and\/or transanal irrigation automatic systems), then a prospective study was conducted. Anal-lipofilling consisted of three phases: lipoaspiration from the abdominal wall, processing of the lipoaspirate with a Lipogems system and intersphincteric injection of the processed fat tissue via endosonographic assistance. A questionnaire based on Krickenbeck\u2019s scale (KS) was administered to the patients to evaluate the clinical outcome. Main Results: Four male patients (three recto-urethral fistula, and one recto-perineal fistula) underwent the anal-lipofilling procedure at a mean age of 13.0 \u00b1 4.2 yrs. There were no complications during or after the procedure. From an initial assessment of the patients there was an improvement in the bowel function at a median follow up of 6 months, with better scores at KS (100% Soiling grade three pre-treatment vs. 75% grade one post-treatment). Conclusions: Even if our Study is preliminary, echo-assisted anal-lipofilling could be considered as a feasible and safe alternative technique in the management of the fecal incontinence in non-responding ARMs patients. More studies are still necessary to support the validity of the implant of autologous adipose tissue in the anal sphincter as a therapy for fecal incontinence in children born with ARMs.<\/jats:p>","DOI":"10.3390\/children7100181","type":"journal-article","created":{"date-parts":[[2020,10,13]],"date-time":"2020-10-13T08:55:53Z","timestamp":1602579353000},"page":"181","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Preliminary Study on the Echo-Assisted Intersphincteric Autologous Microfragmented Adipose Tissue Injection to Control Fecal Incontinence in Children Operated for Anorectal Malformations"],"prefix":"10.3390","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7119-651X","authenticated-orcid":false,"given":"Giovanni","family":"Parente","sequence":"first","affiliation":[{"name":"Pediatric Surgery Department, Sant\u2019Orsola-Malpighi University Hospital, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Pinto","sequence":"additional","affiliation":[{"name":"Plastic Surgery, Sant\u2019Orsola-Malpighi University Hospital, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Di Salvo","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Sant\u2019Orsola-Malpighi University Hospital, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"D\u2019Antonio","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Sant\u2019Orsola-Malpighi University Hospital, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Libri","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Sant\u2019Orsola-Malpighi University Hospital, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tommaso","family":"Gargano","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Sant\u2019Orsola-Malpighi University Hospital, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo Davide","family":"Catania","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Sant\u2019Orsola-Malpighi University Hospital, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Ruggeri","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Sant\u2019Orsola-Malpighi University Hospital, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Lima","sequence":"additional","affiliation":[{"name":"Pediatric Surgery Department, Sant\u2019Orsola-Malpighi University Hospital, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,10,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1055\/s-0037-1607356","article-title":"Social Morbidity in Relation to Bowel Functional Outcomes and Quality of Life in Anorectal Malformations and Hirschsprung\u2019s Disease","volume":"28","author":"Kyrklund","year":"2018","journal-title":"Eur. 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J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1051\/sicotj\/2017029","article-title":"Arthroscopic treatment of chondral defects in the hip: AMIC, microfragmented adipose tissue transplantation (MATT) and other option","volume":"3","author":"Jannelli","year":"2017","journal-title":"SICOT J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1051","DOI":"10.3390\/genes10121051","article-title":"A 24-month follow-up of the effect of intra-articular injection of autologous microfragmented fat tissue on proteoglycan synthesis in patients with knee osteoarthritis","volume":"10","author":"Hudetz","year":"2019","journal-title":"Genes"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1002\/sctm.18-0285","article-title":"Functional outcomes following microfragmented adipose tissue versus bone marrow aspirate concentrate injections for symptomatic knee osteoarthritis","volume":"8","author":"Mautner","year":"2019","journal-title":"Stem. Cells Transl. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1093\/ibd\/izz051","article-title":"Refractory Complex Crohn\u2019s Perianal Fistulas: A Role for Autologous Microfragmented Adipose Tissue Injection","volume":"26","author":"Laureti","year":"2020","journal-title":"Inflamm. Bowel. Dis."},{"key":"ref_7","first-page":"337","article-title":"Intersphincteric anal lipofilling with micro-fragmented fat tissue for the treatment of faecal incontinence: Preliminary results of three patients","volume":"10","author":"Cestaro","year":"2015","journal-title":"Wideochir. Inne Tech. Maloinwazyjne"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"144","DOI":"10.3393\/ac.2018.09.15","article-title":"Effectiveness of Autologous Fat Graft in Treating Fecal Incontinence","volume":"35","author":"Jeong","year":"2019","journal-title":"Ann. Coloproctol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1521","DOI":"10.1016\/j.jpedsurg.2005.08.002","article-title":"Preliminary report on the International Conference for the Development of Standards for the Treatment of Anorectal Malformations","volume":"40","author":"Holschneider","year":"2005","journal-title":"J. Pediatr. Surg."},{"key":"ref_10","first-page":"19","article-title":"Quality of life in children operated on for anal atresia","volume":"23","author":"Molina","year":"2010","journal-title":"Cir. Pediatr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1007\/s00383-011-2950-0","article-title":"A successful treatment strategy in infants and adolescents with anorectal malformation and incontinence with combined hydrocolonic ultrasound and bowel management","volume":"27","author":"Backhaus","year":"2011","journal-title":"Pediatr. Surg. 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