Management of high anal complex Fistula by modified Kshar Sutra therapy

Abstract

Fistula-in-ano is an inflammatory track which has an external opening in the perianal skin and internal opening in the anal canal or rectum. The track is lined by unhealthy granulation tissue and fibrous tissue. As per Ayurvedic perspective the condition can be corelated with Bhagandara. Acharya Sushruta has described Bhagandara in Ashtomahagada as it is difficult to cure. According to Charak Samhita Kshar sutra ligation is one of the effective procedures for Fistula-in-ano. A single case study of 38 years old male patient, suffering from Fistula-in-ano since 2 months has been illustrated here. Patient had complaints of mild pain at perianal region, P/R bleeding on and off, pus discharge on and off and boil at perianal region. After taking detailed history and thorough examination, we decided to treat the patient with Nadi puran (irrigation with medicated oil) using Saindhavadi taila along with internal medications i.e Kaishore guggul and Shanshamani vati for six days. Kshar sutra and non-cutting plain thread (seton) ligation was done on 7th day along with internal medications. Kshar sutra changing was repeated 4 times i.e., on day 14, day 23, day 33 and day 43 till the tract was completely cut and healed.