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)

Management of Recurrent Fistula-in-Ano (Bhagandara) Extending upto Thigh, by Partial Fistulectomy and Ksharasutra Application: A Case Report

In the present modern day's world, anorectal disorders are increasing in number due to sedentary lifestyle. They cause great discomfort and make one’s life miserable. Among these fistula in ano is most common. It is challenging to treat due to its recurrent nature. Fistula-in-ano is an inflammatory tract that is lined by unhealthy granulation tissue and has two openings, an external opening present in perianal skin and an internal opening in the anal canal or rectum. Fistula in ano is correlated with Bhagandara in Ayurveda. Acharya Sushruta has mentioned it among Ashta Mahagada and explained five types of Bhagandara. Many treatment modalities have been given for the treatment of fistula in ano, Ksharasutra application is one of them. It is a minimally invasive para-surgical procedure and induces both mechanical as well as chemical cutting and healing of the fistulous tract. This technique has a high success rate but it is time-consuming and causes minimal complication. A 73 years old male patient came to RGGPG Ayurvedic College and Hospital, with a complaint of pain and pus discharge from his left thigh for 7-8 years, he has been diagnosed with a case of recurrent fistula in ano. The patient was treated with partial fistulectomy along with Ksharsutra application and recovered well with complete excision of the tract.

Shelf-Life Assessment Of Euphorbia Antiquorum Linn., Euphorbia Caducifolia Haines, Euphorbia Nivulia Buch. Ham And Euphorbia Tirucalli Linn. Latex

Objective: In the present study, an attempt was made to assess the shelf life of the Snuhi latex which is frequently used in fresh condition for the preparation of Ksharasutra, a medicated thread, used in Ayurveda. Methods: The latex of E. antiquorum, E. caducifolia, E. nivulia and E. tirucalli were collected individually and stored in air tight glass vials during the month of May, 2018. Physical attributes like Colour, odour, appearances, pH and microbial load of all four samples were assessed as per standard protocol. Assessment was made every day, 9 AM, for 7 d in room temperature and for 10 d in refrigerated samples. Results: Result shows that, pH range (start-end day) was 4.25-5.18, 4.79-5.12, 4.48-4.76 and 4.40-5.42 in case of E. antiquorum, E. caducifolia, E. nivulia and E. tirucalli at room temperature. It was found that, Aspergillus niger was found in Euphorbia antiquorum, Euphorbia caducifolia whereas Candida albicans was found in Euphorbia tirucalli latex in fungal culture on the 7th day after collection, when the samples were stored at room temperature. All the samples were free from microbial growth up to 10thday when stored at 4-5 °C in a refrigerator. Conclusion: Temperature, and moisture affects the quality of fresh snuhi latex. The latex remains free from microbial growth up to six days in room temperature and up to 10 d under at refrigerated temperature (4-5 °C).

A Critical Study Of Ksharasutra Preparation Standardization And New Developments

Ksharasutra is a medicated thread prepared by using plant based ingredients. The active ingredients are coated repeatedly on Barbour thread no 20 so that a required amount of drug gets adhered on the thread to achieve therapeutic value. Charaka mentioned Ksharasutra in the chapter of Sotha Chikitsa. Susruta mentioned its reference in Nadivrana Chikitsa. Vagvat had clearly mentioned along with Shastrakarma, Agnikarma and Ksharakarma. Chakradutta in Arshodikar clearly mentioned the idea of preparation of Ksharasutra with Snuhi Ksheera and Haridra Churna.As the name Ksharasutra itself suggest Kshara should also be one of the ingredients which was missing in the description of Chakradutta. Therefore, Kshara was added subsequently in the preparation of Ksharasutra at the department of Shalya Tantra BHU. Among the various types of Kshara, Apamarga Kshara was selected because of its better clinical efficacy, wider availability of raw material and higher yield of Kshara from the plant. Ksharasutra is a well established procedure in the management of Fistula in Ano with a high success rate. Although the standard Apamarga Ksharasutra is used successfully in the management of Fistula in Ano. Along with the advantages the standard Apamarga Ksharasutra creates many problems during preparation and application of thread. To overcome these problems various types of Ksharasutra research, preparation along with their standardization have been carried out. The research is based on searching for the drugs having better actions and acceptability than that of Snuhi Ksheera and Apamarga Kshara.