eP752 - Ksharsutra Treatment in a Case of Anal Fistula with External Opening at Base of Penis

Purpose/Background: Anal fistula is a common benign disease, but complex anal fistula of this type is very difficult to treat surgically because of its relation with urethra and testies, anal muscles or nervus vascularis. Ksharsutra treatment in such cases not only prevent incontinence but also protect important perineal structures by preventing wide disection, its the time tested parasurgical operation to treat this disease, enhance prognosis and reduce complicationKsharsutra is a medicated thread (chemical seton) prepared by using plant based ingredient. The active ingredients are coated repeatedly on surgical linen (barbour) thread no. 20 so that a required amount of drug gets adhered on the thread to achieve therapeutic value. The thread, when applied judicially, helps in cutting, curetting, draining and healing of fistulous track. Kshar sutra is an old age minimal surgical procedure described in Ayurveda for the treatment of sinus and fistula in ano .Methods/Interventions: A 41 year old male patient was referred to our hospital. With discharging external opening at 6 cm away from anal verge at 1 o'clock position with draining seton in position and another external opening at the base of penis. This patient undergone fistulectomy 18 months ago at the local hospital, but the disease recurred soon. The patient then again undergone one more surgery at another hospital before 8 days, probably the surgeon this time only put the seton and referred him to our hospital .Visual examination presented that there was one external opening at base of the penis on right side and another external opening on left side near anal verge at 1 o'clock. Perrectal examination revealed internal opening at 1 o'clock just distal to anorectal junctionTo check the patency of the tract, we instilled methylene blue dye into external opening at the base of penis which come out from the internal opening Pelvic magnetic resonance imaging MRI revealed fistulas clearly on coronal ,sagital and axial images.Considering this patient’s condition, ksharsootra treatment was chosen to perform,external opening at 1 o'clock was coared till it reaches primary tract which is at the level just below the levator plate, the excised branch of tract send for histopath study. The primary tract intercepted into two separate tracts,the distal tract debried with gauze piece, separate ksharsutras were inserted in both the tracts,the ksharsutra in distal tract changed every week for two weeks and then removed, the ksharsutra in proximal tract was changed by railroad technique every week for twelve weeks by the time the distal tract with external opening at the base of penis get healed completely,After that we decided to go for second sitting under spinal anasthesia, in second sitting we layed open the primary tract by dividing the subcutaneous and superficial external anal sphincter.The invovlved deep part of external anal sphincter was tied with nylon thread and loose ksharsutra for drainage. After six weeks the deep part of external anal sphincter also divided and tract layed open. Histopath examination informed that the excised tissue was granulation tissue and fibrous tissue and no evidence of Tuberculosis or malignancy.Results/Outcomes: Follow up visit after six and nine months revealed that no symptom recurred and continence for solid, liquid stool and flatus was well preserved., on clinical examination both external openings and internal opening with fistula tract were healed.Conclusion/

Discussion: This patient was treated successfully with ancient ayurvedic ksharsutra treatment. we have the legacy over 2000 years."Ksharsutra Treatment In A Case Of Anal Fistula with External Opening At Base Of Penis

External Opening At Base Of Penis
Ksharsutra Treatment In A Case Of Anal Fistula With External Opening At Base Of Penis

Another external opening on left anterior side at 1 o'clock
Ksharsutra Treatment In A Case Of Anal Fistula With External Opening At Base Of Penis

Interception of tract with application of ksharsutra in both proximal and distal tract
Ksharsutra Treatment In A Case Of Anal Fistula With External Opening At Base Of Penis

Interception of tract with application of ksharsutra in both proximal and distal tract "