Fistula-in-ano is a chronic anorectal condition characterized by an abnormal tract between the anal canal and perianal skin, often associated with recurrent infection and discharge. Recurrence remains a major challenge in its management despite various surgical interventions. Ayurveda describes this condition under Bhagandara, which is considered a difficult-to-treat (Kruchrasadhya) disease. Among the various treatment modalities, Ksharsutra therapy and its modified techniques have shown promising results due to their minimal invasiveness and low recurrence rate. This case study presents an 18-year-old female patient diagnosed with fistula-in-ano, having a history of previous surgical intervention. The patient presented with complaints of pus discharge from an external opening near the anal region. After thorough clinical examination and investigations, the patient was planned for surgical management using the PILTEC (Partial Intersphincteric Laser Technique) procedure under spinal anesthesia. During the procedure, the fistulous tract was identified using methylene blue dye and a silver probe. Curettage of the distal tract and intersphincteric fistulectomy were performed, followed by laser ablation of the remaining tract. Proper irrigation with antiseptic solutions was done. Postoperative management included antibiotics, analgesics, wound care, and regular dressing. The patient showed satisfactory recovery with healthy wound healing, minimal pain, absence of active infection, and no complications during follow-up. This case highlights that a combined approach integrating modern surgical techniques with Ayurvedic principles can be effective in managing fistula-in-ano, reducing recurrence, and promoting better healing.
Dr. Kiran Mendhekar1, Dr. Neha P. Shelake2*, Dr. Madhavi S. Banarase3, Dr. Bharat Oza4, Dr. Sanket S. Sangale5 (Sun,) studied this question.