Management of Ano-Bartholin's fistula with interception of fistulous tract with application of Ksharasutra technique: An experience

Fistula-in-ano is one of the most common ano-rectal disorders that has existed since antiquity, whereas Ano-Bartholin’s duct fistula is considered a relatively rare occurrence compared to other types of anal fistulas. It can be well correlated to Bhagandara (~fistula in ano) in Ayurveda based on the similarity in its signs and symptoms such as pain and discharge from the external opening at the perianal region. Over the years, Ksharasutra (~Ayurvedic seton) therapies for fistula-in-ano have shown encouraging outcomes; however, it is not without its downsides, such as a lengthy operation, excruciating postprocedural agony, and a noticeable scar. Despite improvements over the old Ksharasutra procedure, Interception of Fistulous tract and Application of Ksharasutra (IFTAK) is currently a well-known, novel, and innovative treatment for fistula-in-ano. This case report presents a case of a 30-year-old female diagnosed with Ano-Bartholin’s duct fistula with three openings at the labia majora. In this case, the IFTAK approach was employed to treat the trans-sphincteric fistula-in-ano having connection with labia majora, which has given a good surgical outcome with reduced treatment duration, causing less postprocedure discomfort, and leaving minimal scarring. The total duration of treatment was four weeks, and follow-up was done for one year to check the reoccurrence. There is no anal discomfort reported by the patient without any reoccurrence till date.