Fistula in Ano Clinical Trial
Official title:
Case Study of Fistula in Ano Managed by Kshar Sutra, Para Surgical Procedure
Background: Fistula in ano is one of the most common diseases of the ano rectal region.
Treatment of Fistula in ano has puzzled the medical fraternity due to its complex nature.
Commonly prevalent surgical treatment for anal Fistula, that is "Fistulectomy" does not
provide successful cure for the disease, post operative complications and recurrences being
common. Acharya Sushruta an ancient Indian Surgeon has described in his text ' Sushruta
Samhita' about an ancient Ayurvedic technique of medicated thread called Ksharsutra
treatment for Bhagandara ( Fistula in ano). Treatment of anal Fistula (Bhagandara)and
Nadi-Vrana(Sinus) with Ksharsutra was practiced by Sushruta (1000-600B.C.) .
Hypothesis: Aycharya Sushruta advocated Kshar Sutra therapy in Fistula in ano and in various
types of Fistula.
A 48 years old female patient, came with complaints of painful discharging boil at left side
of Perianal region with pain.
She gave a surgical history of incision and drainage for gluteal abscess done in before four
month. On local examination Patient had discharging sinus at 3 o' clock position on left
side of Perianal region. Before planning the treatment other aetiologies were ruled out.
Diagnosis was confirmed by Fistulogram, suggestive of high anal fistula with internal
opening in the anal canal. Under spinal anaesthesia probing was done. Internal opening of
Fistula was confirmed by injecting Methylene Blue dye through external opening. The track
was directed upward in the anal canal without any tributaries. Length of the tract was 9cm.
Then Kshar Sutra was tied covering the entire underlying track for cutting and healing under
all aseptic precaution. The patient was discharged on the next day of procedure. The Kshar
Sutra was changed weekly. To promote healing and to reduce pain and inflammation oral
antibiotics, anti-inflammatory medicine were also prescribed.
The total period of Kshar Sutra treatment was 5 month. The Kshar Sutra was a standard
medicated thread smeared with Kshar of Apamarga (Achyranthus aspera), Shnuhi (Eforbia
Nerrifolia) which has quality of cutting and Haridra(Curcuma Longa) which is used as a
antiseptic. The ph value of the thread thus prepared was determined and its sterilization
effected by ultraviolet rediation. The alkalinity of Kshar Sutra was 9.2ph.
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