Abstract

GOTHEERTHAKA CHEDANA FOLLOWED BY PRATISARANEEYA KSHARA KARMA AND KSHARASUTRA LIGATION IN THE MANAGEMENT OF SHATAPONAKA BHAGANDARA – A SINGLE CASE REPORT

Dr. Yashwanthakumar H.* and Dr. Duragappa H.

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Abstract

Sushruta extensively delineates the Bhagandara disease, classifying it among the Ashtamahagada. Within the five types of Bhagandara, Sambukavarta is deemed Asadhya, while the remaining four are considered Kruchrasadhya. Bhagandara manifests as a canal characterized by unhealthy granulation tissue and pus discharge, akin to Fistula-in-Ano. Specifically, Shataponaka (Vataja) Bhagandara is elucidated by Sushruta, detailing its Nidana, Samprapthi, Purvarupa, and Rupa. Sushruta outlines a Shastra Karma procedure with four distinctive incisions to prevent complications, a methodology that aligns with contemporary fistulotomy and fistulectomy procedures for Fistula-in-Ano. Despite the prevalent use of Ksharasutra in treating Bhagandara, Shastrakarma remains pivotal in managing Shataponaka Bhagandara. Conditions such as fistula-in-ano with multiple openings, tubercular fistula-in-ano, hidradenitis suppurativa, Crohn's disease with fistula-in-ano, uncontrolled diabetic patients with multiple fistula-inano, and perianal actinomycosis fall within the category of Shataponaka Bhagandara. To expedite healing and mitigate the need for multiple incisions, these incisions can be strategically employed in multiple tracks. In this case report, a patient of fistula- in-ano having 3 external opening on left side of anal canal was treated with Gotheerthaka chedana followed by Pratisaraneeya kshara karma and Ksharasutra ligation for the remaining part of tract. Regular dressing was done with jatyadi taila for the Vrana (wound) resulted by Gotheerthaka chedana and old ksharasutra was changed with a new one by rail-road method on every week for the remaining part of fistulous tract. The unit cutting time (UCT) was measured and noted at every week. This case was cured completely within 7 weeks. Hence study concluded that in fistula-in-ano with multiple openings the incisions told by Sushruta can be employed along with Ksharasutra treatment to expedite healing and to avoid multiple incision / Multiple Ksharasutra ligation.

Keywords: Shataponaka bhagandara, Gotheerthaka Chedana, Kshara sutra, fistula-in-ano with multiple openings.