Ksharasutra Surgery for Management of Complex High Anal Fistula: A Successfull Case Demonstrating Definitive Cure”

Abstract

Background: Ksharasutra is an Ayurvedic para-surgical medicated seton used for Bhagandara (fistula-in-ano). Bhagandara is enumerated under Astamahagada[1] and it is a Chedana Sadya Vyadi, clinically which can be correlated to Fistula-In-Ano. It is a communicating track lined by unhealthy granulation tissue; opens internally in the anal canal or rectum and perianal region. Commonly this disease develops after spontaneous bursting or inappropriate surgical drainage of an abscess. It then remains open with pus discharge.[2] The incidence of a Fistula-in-Ano developing from an anal abscess ranges from 26% to 38%, the prevalence rate of Fistula-in-Ano is 8.6 cases per 100,000 population worldwide, in men the prevalence rate is 12.3 cases per 100,000 population and in women it is 5.6 cases per 100,000 population.[3] Depending upon the extent and nature of Fistulous tracks, Acharya Sushruta has described different type of incision in the management of Bhagandara. Here in this article a small attempt has been made to throw light on Sushrutokta Chedana Karma in Bhagandara. We present a detailed case report supplemented with an extensive literature review, procedural standardization, and outcome comparison.