EFFECT OF PARTIAL FISTULECTOMY WITH KSHARASOOTRA APPLICATION IN THE MANAGEMENT OF BHAGANDARA (FISTULA-IN-ANO) – A CASE REPORT

Management of fitula-in-ano by fistulectomy is a surgical challenge due to its high re-occurrence rate. Application of Ksharasootra has been indicated in ano-rectal disorders particularly in the management of Bhagandara (Fistula-in-ano) in Indian system of medicine. Ksharasootra, a medicated thread, was prepared with Apamarga Kshara (Ash of Achyranthus aspera Linn.), latex of Snuhi (Euphorbia nerifolia) and Haridra (Curcuma longa Linn.) powder as per the standard guidelines of Ayurvedic Pharmacopeia of India (API). A case of 40 year male was diagnosed as Bhagandara (Fistula in ano) present anterior side at 11 O’clock site of anal canal which extend to base of scrotum, was treated with partial fistulectomy with Ksharasootra application in remaining part of the tract. In post-operative management, the old Ksharasootra was changed with a new one by rail-road technique on weekly interval. Decrease in the length of Ksharasootra was measured weekly and noted to assess the unit cutting time (UCT). The fistulectomy wound dressing was done daily with Shatadhaut Ghrita (medicated clarified butter). After two months (Ksharasootra changed for 8 times) tract was cut through with Ksharasootra and fistulectomy wound was healed completely with normal scar without any complication. Thus, ksharsutra is very effective with minimum invasive surgical modality for management of Bhagandara (fistula-in-ano). This is sphincter saving procedure as well as easy to perform.