Fistula -in- Ano

Symptoms

• Pain
• Purulent discharge, bloody discharge
• pruritis ani

Treatment

• Ksharsutra therapy
• Fistulectomy and radio waves ablation of fistula track

KSHAR-SUTRA

Kshara Sutra has been described in all the ancient books of Ayurveda as caustic thread not only for the treatment of fistula-in-ano, but also for all those conditions which demand gradual excision of overgrown soft tissues. These conditions include piles, polyps, warts, papilae and also the non-healing chronic sinuses and ulcers where debridement is an essential factor to permit a healthy healing pattern. In this way, Kshara Sutra has wide applications in a number of surgical conditions which often pose problems for the patients and also for the surgeons. This has specific role to play in the common anorectal conditions like piles, fistula and fissures.

1. KSHAR + SUTRA = Ksharsutra
2. Kshar is an alkaline salt of plant origin
3. Sutra is thread
4. Ksharsutra is an Alkaline Medicated Thread.

Mode of action Of Kshar Sutra

Kshar Sutra is now a popular treatment modality in India for the management of fistula in ano. Many clinical trials have been done all over in different institutes to evaluate the action. In countries like India, Srilanka and Japan also many clinical trial has already done and established its action. Precisely the action of Kshar sutra is thought to be due to its healing and cleansing effect according to Ayurveda. It can be suggested that due to the anti microbial action, and as a saton it allows the proper drainage of pus from the fistula, that leads to a proper healing. On the other hand the cutting effect of thread incises the skin gradually with out a surgical incision. Many studies confirm that it is more effective in the way of reducing hospital stay and less infection than the conventional seton therapy. Researches suggests that it is having the cation of excision, scrapping, draining penetrating, debridement, sclerosing, healing, it is bactericidal and bacteriostatic.

• Kshar Sutra has 8 to 9.4 pH (alkaline base).
• It work in main tree ways.
• Curating of Track
• It allows drain
• Cuts the tracks
• Kshar Sutra has alkaline base with rough surface property.

ADVANTAGES AND BENEFITS OF KSHAR SUTRA THERAPY

1. It is a simple, safe and sure treatment for fistula –in-ano (98% success rate)
2. Ksharsutra is - chemical fistulectomy rather than surgical fistulectomy
3. It is a simple minimum invasive surgical technique
4. Recurrence is negligible (3-5%)
5. Performed in Minor O.T. conditions
6. No damage to anal sphincter and chances of incontinence is practically Nil
7. It is an Ambulatory procedure, no hospitalization required
8. Only local/topical anesthesia required
9. No antibiotic coverage required
10. Ksharsutra is very safe in patients who are otherwise not fit for surgery e.g. Diabetics, Cardiac patients, Hypertensives elderly and weak patients.

A New Interventional Kshar Sutra Strategy

• To overcome these lacuna I have created a new interventional Kshar Sutra Therapy in my hospital. In which we used rubber band in the fistula track after first three settings of Kshar Sutra.
• Rubber band has elastic property with smooth surface which gives better performance in cutting and allowing the fistula track.
• Rubber band may be tied with more tension and tighten periodically in this case the rubber band will cut through fistula

A New Interventional Kshar Sutra Strategy

• To overcome these lacuna I have created a new interventional Kshar Sutra Therapy in my hospital. In which we used rubber band in the fistula track after first three settings of Kshar Sutra.
• Rubber band has elastic property with smooth surface which gives better performance in cutting and allowing the fistula track.
• Rubber band may be tied with more tension and tighten periodically in this case the rubber band will cut through fistula
• Rubber band has elastic property with smooth surface. So it gives better performs in cutting and allowing drain.
• Due to elastic property patient does not need weekly setting of band.
• Due to smooth surface it allowing drain better than Kshar Sutra.