2. Excellence of Ksharsutra for the Management of Fistula-in-ano over various Treatments available in Modern Surgery

Dr. Ramadhar Yadav, Lecturer
Ayurveda Campus, Ayurveda Teaching Hospital, TU/IOM

Fistula-in-ano is one of the common disorders in ano-rectal region. Once fistula-in-ano is formed, it fails to heal simply that affects the patient physically and mentally.

Basically, there are three line of treatments available in modern science to treat fistula-in-ano: 1) Conservative treatment or Non-operative 2) Operative treatment 3) Para surgical treatment 1) Non-operative or

1) Conservative treatment

a) In acute stage, antibiotics should be given preferably after pus culture and sensitivity test. Warm sitz bath, bowel regulators and analgesics may also be provided. b) Some irritant chemicals e.g. 4% AgNo3, Bismuth paste and combination of quinine and urethane should be injected in fistulous track. But this procedure becomes unpopular because-

Drawbacks: - It has very high recurrence rate. - It causes inflammation of anal region which causes proctitis and pain during defecation. - It also causes necrosis of the surrounding healthy tissue.

2) Operative Management- This procedure has gained maximum popularity but recurrence rates are also very high presence of a symptomatic fistula-in-ano is an indication for operation spontaneous healing is very rare and neglected fistulae may lead to repeated abscesses formation and persistent drainage with its concomitant morbidity. Operative techniques can be grouped under two categories namely fistulotomy and fistulectomy.

I. Fistulotomy: It includes the incision of track laying open followed by curettage of underlying tissue.

Drawback: Recurrence occurs due to the remained portion of fibrosed and necrotic tissue.

II. Fistulectomy: In this procedure, the total track is excised along with the surrounding unhealthy tissue. This procedure has comparatively better results.

Drawbacks: - This procedure forms a very wide wound and if healing occur from the margin, tunnel forms inside. Therefore, wound should allow to heal from the base and not from the margin.

If there are any remains inside, it should be opened again. - It causes various complications like retention of urine. - Haemorrhage a) Incontinence b) Cellulitis c) Inadequate drainage d) Fecal impact e) Recurrence of fistulae f) Recto-vaginal fistulae g) Persistent sinus h) Stricture etc.

3) Para-surgical management It involves the application of ligature of silk or rubber band.

Drawbacks: - Severe pain for long period during dressing - Delayed healing - Chance of infection

Excellence of Ksharsutra
Action of Ksharsutra:
The cutting of the tract is due to the pressure necrosis of the tissue. It can be achieved by tying any type of thread. The Ksharsutra helps in cleaning:- -debris from the tract -sterilization of the tract It results in quick and good healing of the wound. Ksharsutra by its virtue acts as lekhana (cutting and curettage), shodhana (cleaning) and ropana (healing effects) on the tract.

Supremacy of Ksharsutra over surgical management  

1) Minimal trauma and no tissue loss as compared to the surgical excision. 2) No bleeding in Ksharsutra application while owing to huge amount of bleeding occurred in fistulectomy that requires blood transfusion. 3) Anesthesia is seldom required. 4) The patient is fully ambulatory and can perform his/her daily activities. 5) Minimal hospital stay- in most of the cases not even a day. 6) No dressing as in huge wound of fistulectomy. 7) No incontinence 8) The cost of the therapy is very less. 9) Very narrow and fine scar in comparison to ugly scar of surgery. 10) No anal stricture if properly treated. 11) The recurrence rate is practically nill.

 Source: Ayur Info 4th issue

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