Surgical management of complex Fistula-in-ano (Bhagandara) by Sphincter Preserving Technique (with Ksharasutra Therapy) - A Case Study

Abstract

Surgical management of complex fistula-in-ano is difficult and it is a challenge to any surgeon because there is high chances of recurrence and fear of incontinence due to injury of anal sphincteric muscles during surgical intervention. Sushruta has developed many surgical procedures, Ksharasutra is one of them. It is a medicated alkaline thread, which cut the fistulous tract slowly and gradually followed by healing. It also helps in draining pus from fistulous tract. Its treatment is still a challenge to the surgeons because of its high reoccurrence rate. So, the main goals for the treatment of Fisutula-inAno are preservation of continence, cicatrisation as possible due to low rate of recurrence. In Ayurveda, Ksharasutra therapy could reduce recurrence with success rate of 96.67%. A 30 years/male came to Shalya OPD with complaints of intermittent watery discharge from perianal region. After local examination and investigations he diagnosed as a case of Fistula-in-ano. He got operated thrice already for this complaint. He was put on for Ksharasutra therapy and the patient got cured from fistula with no complications. Therefore, the Ayurvedic surgery has shown potential for larger public health benefits for such type of cases.