Objective. To compare the effectiveness (healing of complex cryptoglandular fistula) and safety (complication rate) of mesenchymal stem cells (MSCs) in combination with filling of fistula with fibrin glue and isolated administration of fibrin glue in patients with complex cryptoglandular fistula.

Material and methods. A systematic review and meta-analysis included studies devoted to isolated use of fibrin glue and topical use of MSCs combined with fistula filling with fibrin glue for the treatment of patients with complex cryptoglandular fistulas. Meta-analysis included 3 randomized clinical trials and 198 patients.

Results. Ryptoglandular fistula healing rate in the MSCs + fibrin glue group in long-term period (12—24 months) was 50-52.4%, in another group — 26.3—37.3% (OR=2.15; 95% CI 1.08—4.29; p=0.03). This confirms the effectiveness of additional administration of MSCs. There were no significant differences in complication rate (abscesses) that indicates safety of technique. Certain factors can affect the results of surgical treatment (method of treatment and washing of fistulous canal, intensive mixing of cell suspension, method of MSC administration and small experience in fistulous canal closure with fibrin glue).

Conclusion. Autologous adipose-derived stem cells are effective and safe for complex cryptoglandular fistula. However, significant limitations of meta-analysis make us cautious about the results and require further randomized trials.

Keywords. mesenchymal stem cells (MSCs), stem cells, stromal vascular fraction, complex anal fistula, fistula-in-ano, cryptoglandular fistula