A Comparative Study to Evaluate the Efficacy of Standard Fistulectomy Procedure and Kshar-Sutra Ligation in the Management of Fistula-in-Ano

Abstract

The disease, fistula in ano, which is considered to be a minor ailment, has high morbidity. Besides fistulectomy; the father of surgery, Sushruta, has also described its treatment in his text Sushruta samhita by kshar sutra method considering it as nadi vrana (wound with tract). The aim of the study was to compare the effectiveness, hospital stay, post operative pain between fistulectomy and kshar sutra procedure. 30 patients underwent fistulectomy and 30 patients underwent kshar sutra procedure according to the inclusion and exclusion criteria of study. Post operative assessment of pain was done using VAS score, fecal incontinence, gas incontinence, wound healing, follow up complaints and recurrence. Mean hospital stay and recurrence was more in fistulectomy procedure and duration of healing of fistula was more in kshar sutra ligation procedure and there was significant difference in pain on 1 st , 2 nd and 3 rd post operative day. Kshar sutra procedure is safe, feasible and effective. In Ksharsutra procedure immediate post operative pain was much less with early discharge from the hospital, complete healing of wound was delayed with decreased morbidity, as compared to open method of fistulectomy.

Comparison of “medicated seton versus fistulectomy” in the management of fistula-in-ano in tertiary care hospital

“…Gouranga D et al; Gupta Shyam K et al and Shukla N et al had similar results. 2,4,6 In present study, no patient from seton treatment group developed incontinence for liquid/flatus/faeces. While 2 (10%) patients from fistulectomy group developed incontinence, one for flatus/liquids and one for faeces.…”

“…Gupta Shyam K et al studied 60 patients of fistula-in-ano and reported recurrence of 3.33% with medicated seton and 10% recurrence with fistulectomy. 6 Shukla N et al in their study reported recurrence of 4% with medicated seton and 11% recurrence with fistulectomy. 4 Post-operative pain was assessed at 6hr, 24 hr and 48 hr on a visual analogue scale.…”

“…Other studies done by Reddy VM et al, Gouranga D et al, Shukla N et al also observed similar results. [4][5][6] Studies Reddy VM et al studied 44 patients of fistula-in-ano. They observed in medicated seton group, maximum time duration needed for operation was 33.54 minutes and minimum time duration was 18.2 min.…”

Management of Pilonidal Sinus With Ayurvedic Ksharasutra Therapy: A Case Study

“…There is simultaneous cutting and healing of the tract and no pocket of pus is allowed to stay back. 19 Thus it provides an environment for healthy granulation tissue to develop providing an avenue for nadivrana (sinuses) to heal completely. Further application of ksharasutra was described by Sushruta as direction of the sinus should first be ascertained by a probe.…”

Ksharasutra Application in Pilonidal Sinus – A Case Study.

“…So kshara are not only cause the destruction (lysis)of unhealthy tissue but also help in their debridement. Hence this is an ideal procedure to be adopted for the management of sinus track as it not only destroy the fibrous wall of track as it not only destroys the fibrous wall of track but help in its curettage.There is simultaneous cutting and healing of the tract and no pocket of pus is allowed to stay back [13] . Thus it provides an environment for healthy granulation tossue to develop providing an avenue for nadivrana(sinuses) to heal completely.further application of ksharsutra was described by a probe.A ksharsutra was described by Sushruta as direction of the sinus should first be ascertained into the track and brought out from the other end with the help of probe.The two ends of the thread should be firmly tied together.Anather ksharsutra should adopt a similar procedure in case fistula-in-ano [14] .…”