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Anal fistula / fistula-in-ano

Anal fistula / fistula-in-ano

Anal fistula / fistula-in-ano, is a chronic abnormal communication between the epithelialised surface of the anal canal and (usually) the perianal skin. An anal fistula can be described as a narrow tunnel with its internal opening in the anal canal and its external opening in the skin near the anus. Anal fistulae commonly occur in people with a history ofanal abscesses. They can form when anal abscesses do not heal properly

Anal fistulae originate from the anal glands, which are located between the internal and external anal sphincter and drain into the anal canal.[4] If the outlet of these glands becomes blocked, an abscess can form which can eventually extend to the skin surface. The tract formed by this process is a fistula.[1]

Abscesses can recur if the fistula seals over, allowing the accumulation of pus. It can then extend to the surface again - repeating the process.

Anal fistulae per se do not generally harm, but can be very painful, and can be irritating because of the drainage of pus (it is also possible for formed stools to be passed through the fistula). Additionally, recurrent abscesses may lead to significant short term morbidity from pain and, importantly, create a starting point for systemic infection.

Treatment, in the form of surgery, is considered essential to allow drainage and prevent infection. Repair of the fistula itself is considered an elective procedure which many patients opt for due to the discomfort and inconvenience associated with an actively draining fistula.

Treatment -

Ksharasutra Therapy is an Ayurvedic Parasurgical Technique. Great Indian Surgeon Sushruta narrated in his teachings the use of Kshara for cure of fistula in ano and other anorectal diseases. The work of Sushruta was later compiled as "Sushrut Samhita" in the 5th century A.D. Acharya Chakrapani Datta (10-11 Century A.D.) and Acharya Bhav Mishra (16-18 century A.D.) have described in their classical Ayurvedic texts, the method of preparation and treatment of fistula in ano by use of Kshara Sutra (K.S.). It is being used for the successful treatment of Anorectal Diseases from many years.

In this technique, a specially prepared thread (Kshar Sutra) is used to cure diseases. Kshar Sutra acts by "Herbal Chemical Cauterisation" and removes the disease from the body.

Many studies have been published by Ayurvedic doctors recently with encouraging results for treatment of fistula in ano and other anorectal diseases by use of Kshara Sutra

Fistula treatment 1 Laser surgery

The procedure is done under short General Anaesthesia and requires about 30-40 minutes. A radially emitting Laser Fibre is inserted from the outside. A defined amount of laser energy is then emitted circumferentially into the fistula tract. The laser energy causes controlled photothermal destruction of the fistula tract causing it to collapse to a high degree. This also helps supports and accelerates the healing process.

  • it has an excellent healing rate as compared to all other techniques.
  • The anal sphincter is preserved so there is no risk of post-operative incontinence.
  • It can be done in complicated fistulas like recto-inguinal, recto-gluteal fistulas.
  • It is safe in high risk patients like those with hypertension, cardiac (heart) problems and in senior citizens.

Fistula tratment 2 Mode of Action of Kshar Sutra:

  • 1. The cut through of fistulous tract is effected by the pressure exerted on anorectal tissue by the moderately tight Kshar Sutra tied in the fistulous tract.
  • 2. The presence of Kshar Sutra in the fistulous tract does not allow the cavity to close down from either ends and there is a continuous drainage of pus along the Kshar Sutra itself.
  • 3. The Kshar Sutra slowly and gradually cuts through the fistulous tract from apex to the periphery. There is an ideal simultaneous cutting and healing of the tract and no pocket of pus is allowed to stay back.
  • 4. The Kshara (Caustics) applied on the thread are anti-inflammatory, antislough agents and in addition, have property of chemical curetting. The Kshar Sutra remains in direct contact of the tract and therefore, it chemically curettes out the tract and sloughs out the epithelial lining, thereby allowing the fistulous tract to collapse and heal.
  • 5. The Kshar Sutra, due to its antibacterial property, does not allow bacteria to multiply in its presence.
  • 6. The pH of Kshar Sutra was towards the alkaline side and therefore it did not allow rectal pathogens to invade the cavity.

Benefits of the Ksharsutra Therapy:

  • 1. It is an Out Patient Treatment.
  • 2. Performed mostly under Local anesthesia.
  • 3. Only 30- 45 minutes is required for the procedure
  • 4. Hospital stay is usually minimum (5-6 hrs).
  • 5. Minimal bed rest is required after the procedure.
  • 6. Patient can resume his / her daily routine within 3 to 5 days.
  • 7. The recurrence rate is very less after Ksharsutra ligation procedure
  • 8. Most important benefit of Kshar Sutra Therapy over Modern Surgeries is that the muscles that supports the Anus and helps in controlling the bowel movements are not dissected and hence the possibility of Anal Incontinence (loss of power to hold stools) is not there.