Management of Complex Trans sphincteric Fistula in Ano with Distal Fistulectomy with Proximal Staged Fistulotomy using Ksharasutra: A Case Study

Abstract

According to Sushruta Samhita, Bhagandar is one of the Ashta Mahagada. Because of its recurrent nature, this condition is more challenging to cure. Ksharasutra has already demonstrated efficacy in treating fistula-in-Ano. In this case report, a 42-year-old male patient had complaints of pain at the perianal region, boil at the perianal region with pus discharge for 1 year. On examination, external opening is present at 3 o’ clock position, and an internal opening is at 6 o’clock position. Induration palpated from 3 to 6 o’ clock position. Transrectal ultrasonography (TRUS) revealed trans-sphincteric fistula-in-ano. Patient underwent partial fistulectomy with ksharasutra application under sadal block. After 2 weeks, two Ksharasutra placed in external fistulous tracts were removed when the track got healthy, and the one connected with the external opening was changed weekly once by the railroad method. Within 7 weeks, the wound was healed completely and without any recurrence.