Journal of Ayurveda and Integrated Medical Sciences

Fistula-in-Ano (Bhagandar) is a chronic granulating tract cavity communicating the rectum or anal canal to the perineal skin. The ideal treatment for Fistula-in-Ano is to eradicate primary source of infection. Fistulotomy or fistulectomy have good results in simple low anal fistula. In complex Fistula-in-Ano there are high chances of recurrence, incontinence and loss of natural anatomial structure.

In Ayurveda there is reference for Fistula-in-Ano as Bhgandar. It can be treated by total excision or laying open. Sushrut (500 B.C.), the Father of Surgery has mentioned safe, alternate and minimally invasive treatment of Ksharsutra (Medicated Seton). Now a days Ksharsutra is prepared by smearing Apamarg Kshar, Snuhi Ksheer and Haridra on surgical linen thread No. 20.

The duration of treatment of Ksharsutra is long depending on the length of tract, patient have to give follow up till cutting of whole tract weekly.

To overcome these problems now a days IFTAK (Interception of Fistula Tract with Application of Ksharsutra) is practiced. In this procedure only proximal, small part of tract is laid open and Ksharsutra applied to that much part only. In this procedure there are no chances of sphincter damage.

After IFTAK now a days irrigation with Betadine daily is practiced, we have tried Saindhavadya Taila for faster healing of the fistula tract and IFTAK wound.

To see the efficacy of Saindhavadya Taila in Bhagandar followed by IFTAK.

To find the most convenient, simple and cost effective management of Bhagandar.

Drug Source: Saindhavadya Taila

Saindhavadya Taila contents:

Saindhav, Chitrak, Danti, Palash, Indrayan, Gomutra, Lohbhasma, Katu Taila,

• As comparative to Betadine, healing of fistulous tract i.e., time duration was less with Saindhavadya Taila due to debridement of fistulous tract.
• Patient has less pain during treatment.
• Patient has less pus discharge.
• Demonstration of the IFTAK Technique

Figure 1: Pre OP

Figure 2: Post OP

Fistula-in-Ano is generally difficult to treat and cure. There are always high chances of recurrence and incontinence.

Ksharsutra treatment has high rate of success and cost effective. Patient after Ksharsutra treatment remain ambulatory and can resume his work early as compared to Fistulectomy or Fistulotomy.

Conventional Ksharsutra therapy has some disadvantages like prolonged treatment, multiple hospital visits for Ksharsutra change.

IFTAK (Interception of Fistula Tract with Application of Ksharsutra) is minimally invasive technique. It is based on eradication of primary source of infection (infected anal crypt) by the application of Ksharsutra.

Ksharsutra which is applied in proximal tract helps in debridement of tract and resulting in good healing of wound. Alkaline nature of drugs which are coated with Ksharsutra gives unfavourable condition to microbial growth.

Cutting and healing of tract take place simultaneously. So, there are almost no chances of damage to sphincter and incontinence.

The aim of Fistula-in-Ano treatment is eradication of cryptoglandular infection i.e., root cause. In IFTAK technique eradication of cryptoglandular infection is done with the application of Ksharsutra and the distal part of the fistulous tract is left to heal without cutting or laying open.