Abstract

INTERCEPTIVE LESS INVASIVE KSHARSUTRA THERAPY IN TRANSPHINCTERIC FISTULA IN ANO

*Dr. Praveen Kumar Choudhary

Abstract

Fistula in ano is a chronic granulation track opens deeply in anal canal or rectum and superficially on the peri-anal skin.[1] Park’s classification of 1976 gives an accurate anatomical course of fistula in ano and he has classified fistula in 4 types such as intersphincteric, transphincteric, suprasphincteric and extrasphincteric.[2] In transphincteric fistula, the fistulous track opens up in to the peri-anal skin after passing through internal and external sphincters both. Usually these fistulae have long tracks even in low anal fistula. Ksharsutra has been emerging as a specialized treatment modality approved and standardized by Indian Council of Medical Research.[3] Ksharsutra is a medicated Seton and it is very good to treat high anal complex fistula.[4] Transphincteric fistula being a long track fistula causes extended morbidity both in case of surgery and ksharsutra therapy. In the present study, a method was devised in which the fistula track was intercepted just outside the sphincter complex and the entire track was divided in to sub tracks. The inner track contained sphincters and the outer track contained skin and subcutaneous tissues. The 20 patients were randomly selected, 10 each in group A (control) and group B (treated) group. The group A was managed by conventional therapy and group B was managed by interceptive method. The morbidity and duration of treatment was significantly less in group B. The mean healing time in group B was significantly shorter than group A. It was concluded that the interceptive less invasive ksharsutra therapy is a better alternative of conventional ksharsutra therapy and morbidity, duration of treatment is less. The healing was faster with a fine scar.

Keywords: Fistula in ano, Ksharsutra, Interceptive ksharsutra, Transphincteric fistula, Cryptoglandular infection, anal sphincters.