Innovative Approaches in Fistula-In-Ano Management: Evaluating the Role of Fistula Brush - A Case Study

Abstract

Introduction: Fistula in ano is one of the most common anorectal diseases. The prevalence is greater in men than women, with the rate of 12.3 cases per 100,000 and 5.6 cases per 100,000, respectively. In Ayurvedic Science Ksharasutra ligation is one of the most popular treatment modality for Bhagandara. Ksharasutra is indeed a well-known treatment in Ayurveda, particularly for managing conditions like pilonidal sinus and anal fistulas. However, it does have some limitations. Hence, an innovative technique is adopted by introducing a new Yantra i.e., Fistula brush in the field of Shalya Tantra for minimizing the unit cutting time in fistulous tract. Methodology: The fistulous tract was curetted using the fistula brush in 4-5 strokes followed by primary threading with barbour thread. Follow up thread change was done after curetting the tract using fistula brush until the tract was cut through. (under local anaesthesia). Result: The intervention results indicated a marked improvement in both subjective and objective parameters, demonstrating the intervention's effectiveness in enhancing patient outcomes. Discussion: The treatment of anal fistula through curettage of the tract using a fistula brush has been demonstrated to be a cost-effective and accessible method. This technique facilitates the removal of unhealthy granulation tissue while ensuring adequate drainage with the use of a drainage seton, thereby promoting the formation of healthy granulation tissue. Ultimately, this process encourages fibrosis of the tract and minimizes the risk of sphincter damage. Mechanical debridement plays a pivotal role throughout the stages of wound healing by promoting a clean, healthy wound environment. By alleviating symptoms associated with each stage - such as pain, burning sensation, discharge and local tenderness - it ultimately enhances the healing process and improves patient comfort.