Partial Fistulotomy followed by Kshara application and Ksharasutra Ligation in Fistula-in-ano - Multiple approaches in a Single Case

Abstract

Bhagandhara is one of the common ailments pertaining to Guda and it is mentioned under the heading of Ashtomahagada (eight major diseases). According to Acharya Susahruta, ‘Bhagandhara’ starts as deep-seated pidika (boil) surrounding Guda (anus) within two Angulas, producing fever and pain. In contemporary science it is compared to fistula-in-ano. Fistula-in-ano is a track lined by granulation tissue and communicating two epithelial lined surfaces which opens deeply in the anal canal or rectum and superficially on the skin around the anus. In modern medical science various treatment modalities has been explained but they are having its own merits and demerits.  Ksharasutra is a medicated thread, indicated in ano-rectal disorders particularly in the management of Bhagandhara. In plane Kshrasutra the required time for cut through and healing of wound is more, so patients are mentally disturbed with this disease. Hence to minimize the required time, multiple interventions along with Ksharasutra is opted. In this case report, a patient of fistula- in-ano having 9cm at posterior aspect of anal canal was treated with multiple approaches which are partial fistulotomy, Kshara application and Ksharasutra ligation for remaining part of tract. Regular dressing was done with Jatyadi Ghrita for the partial fistulotomy wound and old Ksharasutra was changed with a new one by rail-road method on every week for the remaining part of fistulous tract. The unit cutting time (UCT) was measured and noted at every week. This case was cured completely within 7 weeks. Hence study concluded that the long fistula cases can be treated with multiple interventions along with Ksharasutra.