Fistula-in-ano is a chronic abnormal communication,usually lined to some degree by granulation tissue; which runs outwards from the anorectal lumen(the internal opening) to an external opening on the skin of the perineum or buttock(or rarely, in women, to the vagina).1 Anal fistulas arise from cryptoglandular infection (90%) and systemic causes (10%).2 The mean incidence has reported at 8.6 per 1,00,000 individuals. The prevalence is greater in men than women,with a rate of 12.3 cases per 1,00,000 and 5.6 cases per 1,00,000 respectively.3 Modern management of Fistula-in-ano includes fistulotomy(60-70%), cutting seton (2030%), fistulectomy(10-20%), LIFT technique (Ligation of intersphincteric fistula track-10%), Advancement flaps (2-5%), Anal fistula plug repair (5%).4 Acharya Sushruta advocates Paatana, chedana, ksharakarma and agnikarma as a line of management.5 Ksharasutra is used for the management of Bhagandara with the efficacy of 93%-100%.It has some shortcomings such as prolonged duration of treatment in fistula with an increased tract length,pain during ksharasutra changing and requires frequent follow up.
Dr Shilpa P N2 Dr. Zahida K.*1 (Sun,) studied this question.