Fistula-in-ano is a chronic inflammatory condition characterized by an abnormal tract communicating between the anal canal and perianal skin. It commonly presents with recurrent perianal abscess, pus discharge, pain, itching and discomfort. In Ayurveda, fistula-in-ano can be correlated with Bhagandara, one of the Ashta Mahagada described by Acharya Sushruta. Conventional surgical procedures for fistula-in-ano are often associated with recurrence, delayed wound healing and sphincter damage leading to incontinence. Ksharsutra therapy is an Ayurvedic para-surgical procedure using medicated thread for simultaneous cutting, drainage and healing of fistulous tract. The present case report highlights the successful management of trans-sphincteric fistula-in-ano by minimally invasive partial fistulectomy with Ksharsutra application. A 41-year-old male patient presented with complaints of recurrent perianal boil, pus discharge, constipation and itching since one year. MRI fistulogram confirmed trans-sphincteric fistulous tract in the left anterior perianal region. The patient was treated with partial fistulectomy followed by Ksharsutra application under local anaesthesia. This procedure facilitated proper drainage of pus, reduced wound size and promoted simultaneous cutting and healing. The patient required only 2-3 Ksharsutra changes and achieved complete healing within 4 weeks with minimal postoperative pain and no anal incontinence. The procedure proved to be cost-effective, minimally invasive and associated with low recurrence.
Dr. Ramesh V. Ahire*1, Dr. Shantanu S. Somwanshi2, Dr. Brinda S. Patil3, Dr. Aparna A. Raut4 (Wed,) studied this question.