Fistula in Ano by Ksharsutra

A 56-years-man Ramautar, a farmer by profession belongs to Rewan Village in District Hamirpur, Uttar Pradesh. He reported to Jankikund Chikitsalaya with complaint of repeated episodes of pain, swelling and pus discharge from around the anus. He was treated several times in the past at different hospitals for a perianal swelling thought to be an abscess. At times it was incised and drained and at other times was sought to be contained with antibiotics.The treatment often resulted in arresting the symptoms for the time being but would recur after few weeks at newer places around the anus with the similar symptoms and presentations. There were no complaints of abdominal pain or frequent stools. There was no history of passing mucus or blood per rectum. There was no history of the patient undergoing any other surgical procedure or of suffering from any major illness in the past. There was no history of tuberculosis in the family.

After confirmation of fistula in Anothe track was cleaned with betadine and Hydrogen peroxide. The Kshar Sutra was tied covering the entire underlying track for simultaneous cutting and healing under all aseptic precaution. The patient was discharged on the next day of procedure. Patient was advice for Seitz bath with lukewarm water. 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 8 months (11 sittings). The track cut through and simultaneously healed. It was observed that healing rate was slow as compare to cutting rate. The patient is under observation for a period of two year to check for recurrence.

The Kshar Sutra is a standard medicated thread smeared with Kshar of Apamarga (AchyranthusAspera), Shnuhi (Euphorbia Nerrifolia)latex which has quality of cutting and Haridra (Curcuma Longa) which is used as an antiseptic. This combination of drugs on the thread helps in debridement and simultaneously healing.