Management of complex fistula-in-ano by interception of fistula track with application of ksharasutra (IFTAK): a novel technique

Objective: Despite all the technological advances, successful management of complex fistula-in-ano is still a challenge due to recurrence and incontinence. The present study evaluates the outcomes of a novel technique, Interception of Fistula Track with Application of Ksharasutra (IFTAK) in terms of success rate and degree of incontinence. Methods: In the present prospective study, 300 patients with complex fistula-inano were treated by the IFTAK technique, whose surgical steps include: incision at the anterior or posterior midline perianal area, identification and interception of the fistulous track at the level of the external sphincter, rerouting the track (and extensions) at the site of interception, and application of a ksharasutra (medicated seton) in the proximal track (from the site of interception to the internal opening) that is laid open gradually, with the resulting wound healing with minimum scarring. The distal track is allowed to heal spontaneously. Results: There were 227 transsphincteric and 73 intersphincteric varieties of fistula with supralevator extension in 23 cases, of which 130 were recurrent fistulas, 29 had horseshoe track, while 25 had blind fistula with no cutaneous opening. The mean duration of the ksharasutra application was 8.11 ± 3.86 weeks with an overall success rate of 93.33% at the 1-year follow-up. A total of 3.67% of the cases reported with a mild impairment of continence on the Wexner incontinence scoring system. Pre- and postoperative anal manometry evaluation showed minimal reduction in median basal and squeeze pressures. Conclusion: The IFTAK technique is a minimally invasive, daycare surgical procedure for the management of complex fistula-in-ano with low recurrence and minimal sphincter damage. (AU)

IFTAK KSHARA SUTRA TECHNIQUE FOR THE MANAGEMENT OF INTERSPHINCTERIC PERIANAL FISTULA–IN–ANO–A CASE STUDY

An internal opening (primary opening) in the anal canal or rectum and an exterior opening (secondary opening) in the perianal skin combine to form a ?stula-in-ano, an infiammatory track. Unhealthy fibrous tissue and granulation tissue line this tract. Intersphicteric fistulas are ones that cross the internal sphincter and then have a tract to the outside of the anus leading1. The prevalence of an anal abscess-induced fistula-in-ano ranged from 26% to 38%.In men,the prevalence is 12.3 cases per 100,000 population and in women, it is 5.6 cases per 100,000 population2. Fistula-in-ano is a complicated disease, its signs and symptoms which resembles bhagandara disease described in ?yurved?. ?c?rya su?ruta mentioned this disease under aa mah?gad?s which means difficult to cure. For the management of this painful disease many treatment modalities are enumerated in ?yurved? classics and k?ra s?tra therapy is one among them which is proved to be gold standard. Though k?ra s?tra therapy is a big revolution in the field of fistula in ano, but it has some disadvantages like it is time consuming process, severe post-procedural pain, and big scar marks. In the present case report,A 24yr old male p/t c/o pain and swelling in perianal region since three months and successfully managed with IFTAK (Interception of Fistulous tract and application of Ksharsutra) technique. which showed a greatpotential in management by minimizing the duration of treatment, mild post procedural pain and minimum scar mark