Management of Recurrent Complex Grade V High Anal Fistula by dual Ksharsutra Technique: A Case Report

Abstract

Ksharasutra therapy is long known for effectively treating Fistula-in Ano (Baghandara). This study aims to evaluate the efficacy of dual Ksharasutra insertion technique into recurrent complex Grade V high anal fistula (Baghandara). A patient diagnosed with complex (Grade V) Trans-sphincteric fistula (8.6 cm linear length) with supralevator extension previously operated twice, was advised to undergo Ksharasutra therapy. A dual Ksharsutra technique was used. One Ksharsutra was passed into the original track with external opening at 5 o’clock and possible internal opening above the dentate line and another Ksharsutra was passed through the same track with an artificial internal opening was made below the dentate line in the same plane. The study demonstrates the efficacy of dual Ksharsutra technique to mitigate the fistulous track with quick effective drainage and reducing the cut through time without damaging the internal sphincter musculature. Ksharsutra placed above the dentate line was removed later and the cut-through was achieved by 2^nd one. Results: Efficacy was assessed from insertion to complete wound healing. A significant decrease in odour of the puss decreased in 3 weeks. Puss discharge reduced in 16 weeks following which one Ksharsutra was removed. Cut through was achieved in 24 weeks. Complete wound healing was achieved in 26 weeks with no incontinence. Follow showed no signs of recurrence. Conclusion: Dual Ksharasutra technique offers the advantage of faster tract cutting without sphincter injuries or risk of incontinence, more efficient disinfection, quicker wound healing and low risk of recurrence in high anal complex fistula-in-ano (Baghandara).