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Anorectal Care Fistula Treatment

Fistula in Ano- Challenge for Modern Surgery but curable by Ayurveda Ksharsutra Treatment.

Fistula in Ano - Challenge for Modern Surgery but curable by Ayurveda Ksharsutra Treatment

Anal Fistula

Anal Fistula is a disease for which different methods of treatment have been advocated time to time, Even today when we are talking about robotic surgery, this disease has no satisfactory method of treatment in modern surgery. The various methods of treatment like video assisted anal fistula treatment (VAFT) MAFT, LASER, glue , cutting ceton etc are not satisfactory due to high incidences of recurrences after the surgery.

In Ayurveda, about 2000 yrs ago Acharya Sushruta has indicated Kshar Sutra treatment for fistula-in-Ano. Late professor P J Deshpandey at faculty of Ayurveda Institute of Medical Sciences B H U, had done extensive research in this field and established a treatment module to cure this disease. In 1990, Indian council of medical research has clinically evaluated this ayurvedic treatment module at four premiere institutes in our country including AIIMS Delhi & P G I Chandigarh . Subsequently it was concluded by I.C.M.R. that, Ksharsutra treatment is more effective & convenient as compared to modern surgery in the patients of fistula in ano.

Ksharsutra Treatment

Ksharsutra is a thread coated with certain ayurvedic medicines known for their antiseptic, debridement & healing properties. After UV sterilization this medicated thread (ksharsutra) is used under complete aseptic precautions in the patients. The patient is routinely investigated with special reference to any other associated disorder like hypertension, diabetes mellitus, tuberculosis etc. The next step lies In the proper identification & evaluation of the fistulous tract. It is mandatory to define the fistula tract wrt its depth, direction & branching pattern. This may be achieved by careful probing under expert hands using malleable probes & if required help may be taken from other investigations methods like x ray fistulogram or mri fistulogram. Once the tract has been clearly defined the ksharsutra is placed in it with the help of certain instruments, under local anesthesia. This entire procedure is usually completed in ten to fifteen mins. As there is no cutting of tissues hence no bleeding, no pain & patients can go home after half an hr rest in the day care room. The medicine coated on the thread is gradually released in the tract. The cumulative effect of the coated drugs exerts a powerful debridement effect on the fistula tract & induces healing by the fresh & healthy granulation tissues. Thus kshara sutra is the mechanism of drug delivery precisely at the tissues involved. Every seventh or tenth day the old sutra is replaced with a new KSutra till there is a finale cut through. 

It has been observed that the tract heals @ 0.5-1 cm per week. The postoperative complications like recurrence of the disease, fecal incontinence, bleeding is not seen with kshara sutra treatment. Further this therapy is performed as an OPD procedure. No general anesthesia & no hospitalization is required. Patient maintains his normal routine activities as usual during treatment period.

Sushruta Ano Rectal Institute (Ayurcure)

 At Sushruta Ano-Rectal Institute, we have been working on this disease including Piles, Fissures & Pilonidal Sinus treatment for the last 15 years. Here we have developed the concept of Graded Kshar-sutra which has given us a more effective & convenient way to treat anal fistula on record,  At Sushruta Ano-Recta Institute institutes we have treated thousands of patients of anal fistula from different states incuding overseas patients. We have records to prove that the patients of high anal complex fistula, those have been operated two or three times but failed to heal were successfully cured at this institute.

This highly specialised treatment procedure is also used to treat various other diseases including Piles, Anal Fissures with sentinel tags, Pilonidal Sinus etc by Ayurvedic surgical specialist.

Dr. S.K Singh (Gold Medalist)
M.S. (Ayurveda) B.H.U.
Member – National Academy of Ayurveda (Govt of India)

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Anorectal Care Fistula Treatment

Top 10 Treatments for Fistula​

Top 10 Treatments for Fistula

Ksharsutra Treatment

It has been proved to be a highly effective treatment for Anal fistula. A Clinical trial was conducted by Indian Council of Medical Research (ICMR) in 1991 at various medical institute including All India Institute of Medical Sciences (AIIMS) New Delhi and PGI Chandigarh etc. to see the effectiveness of Ksharsutra Treatment. It was concluded that Ksharsutra treatment is more effective and more convenient as compared to surgery in the patient of Anal Fistula. With the latest concept of Graded Ksharsutra (Sushruta Anorectal Institute; New Delhi), the chances of recurrence after Ksharsutra treatment are predictably zero.

Ksharsutra is a medicated thread which is prepared by coating of certain herbal latex with herbomineral powders. The thread is alkaline in nature and it has highly selective debridement property. The fistulous tract is properly defined using MRI fistulogram or clinical probing and then with the help of certain instruments; the thread is placed in the fistulous tract. The medicine is gradually released in the tract from the thread and do the necessary debridement of the fistulous tract. The thread is changed at weekly interval till there is a final cut through and the tract has healed completely. So here it is the medicine which debrides the fistula and ensures complete healing. The thread is just working as a vehicle for drug delivery in Fistula Tract. The anal fistula patient in whom fistula has recurred after Fistulectomy/ Colostomy/ Glue/ MAFT/ VAAFT; these patients have been successfully treated by Graded Ksharsutra. The treatment is equally effective in the case of complex high anal fistula (Supra levator/ trans sphincteric/ horseshoe shaped multiple tracts).

Other Fistula Treatments

  1. Lay-open of fistula-in-ano: In this procedure; an operation is carried out to cut the fistula open. After that, it is regularly packed on daily basis to ensure proper healing of the wound. It left’s behind a scar tissue and depending upon the location of Fistula in relation to sphincter muscles there might be some risk of stool incontinence and if it is not healed properly; there are chances of recurrence.
  2. Cutting seton: This treatment involves inserting a tube in fistula tract and tying it outside the body. Seton is tightened on regular basis to ensure cutting the fistula tract. So it is the tightened seton which causes cutting of tract. This procedure might involve too much pain and in some cases, there might be incontinence especially of flatus.
  3. Fistulectomy: It is a surgical procedure where complete Fistula tract is excised (cut out). In certain cases; there might be more than 1 surgery. Recurrence of fistula and stool incontinence are the possible post-treatment complications.
  4. Colostomy: In this procedure; an opening is made by drawing part of the colon through an opening to the anterior wall of the abdomen. A Stoma appliance is fixed to this opening to make an alternate way for stool to leave the body. This procedure is done to avoid contact with the faecal matter with Fistula assuming that it will lessen the chances of infection and fistula will heal easily. Along with recurrence of fistula and incontinence, there are certain other complications in this procedure like the formation of hernia near Stoma opening, Stomal blockage; another fistula formation near Stomal opening etc.
  5. Fibrin glue injection: In this procedure; biodegradable glue is injected into the fistula tract which is supposed to close the fistula and let it heal naturally. The recurrence rate in Fibrin glue injection is as high as 30-35%.
  6. Fistula plug: This treatment involves plugging the fistula tract from inside with a plug made up of intestinal tissue. The complication in this treatment involves treatment failure, plug extrusion, abscess at the site of plug etc.
  7. Endorectal advancement flap: In this procedure; an internal opening of Fistula is identified and a mucosal flap is cut around the opening and opening is closed with this flap. After that external opening is cleaned and sutured. The main complications in this treatment are the failure of treatment and recurrence of fistula.
  8. LIFT Technique: Ligation of Intersphincteric Fistula tract procedure; involves the closure of internal opening of Fistula tract and removal of infected tissue. Recurrence of Fistula is the main complication in LIFT procedure.
  9. VAAFT (Video-Assisted Anal Fistula Treatment): With fistuloscope fistula tract is visualized and location of an internal opening is confirmed. After that internal opening is closed using stapler or flap made from a layer of skin and the internal layer of the intestine. Disadvantages of VAAFT include reopening of the internal opening leading to failure of treatment and recurrence of fistula.

In case you have a concern or query you can always consult with us & get answers to your questions. Book An Appointment for Fistula Treatment!

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Anorectal Care Fistula Treatment

Fistula-In-Ano: 7 Important Things You Must Know

Fistula-In-Ano: 7 Important Things You Must Know

Fistula-in-ano generally cause discomfort due to pus or watery discharges and sometimes pain. This is a condition where a nodular swelling appears in the area surrounding the anal opening. Intermittent pus discharge is noticed from this nodular swelling. Instead of a nodular swelling; there might be simply an opening in this region. An anal abscess is one of the most common causes of this condition. 

Seven important things you should know about the Anal Fistula:

  • It is curable through Ayurveda only: Till date many treatment options are tried to cure Fistula which include Fistula Surgery/ Glu technique/ cutting seton/ Colostomy/ Fistula plug/ VAAFT and many more. But all of these treatment methods have a pretty high recurrence rate of about 20-25 %. However with Ksharsutra treatment for Fistula; chances of recurrence are negligible. Other complications generally seen in surgery like bleeding, incontinence (inability to hold stool); are not seen with Ksharsutra Treatment. Clinical trials conducted by Indian Council for Medical Research (ICMR); at AIIMS New Delhi and PGI Chandigarh in 1992 have proved that Ksharsutra treatment is more convenient and more effective than Surgery in the patients of Fistula.
  • There are symptoms you can look out for: Some of the symptoms that indicate Fistula include appearance of a nodular swelling in area surrounding stool pass area. Intermittent pus discharge is also observed from this swelling. Usually pain subsides and opening closes after the discharges; and the patient feels relief. But after a certain interval of time again pus accumulates; swelling re-appears with some amount of pain which is again relieved after the discharge. This cycle is repeated at varying interval in the patient of Fistula.
  • Medication can only provide temporary relief: Antibiotics and painkillers might give temporary relief from the symptoms. But after some time there will be again pus formation and associated swelling & pain in area surrounding stool pass opening. 
  • Anal Fistula can recur after surgical treatment: As discussed above all the treatment options tried by modern medicine (including most recent treatment VAAFT) have high incidence of recurrence (about 20-25%) Whereas there are negligible chances of recurrence after Ksharsutra Treatment for Fistula.
  • Anal Fistula treated by Graded Ksharsutra does not recur: Ayurvedic treatment for Fistula is known as Ksharsutra therapy. This involves the use of medicated thread being ligated in Fistula Tract. The medicines present in this thread act as a strong debriding agent and induce healing of the Fistula tract. In a few weekly sittings of Ksharsutra change; Fistula gets healed completely and it does not recur. Patient can maintain his normal routine life during the treatment period.
  • Sitz bath can be beneficial: This involves sitting in a tub filled with warm water so that the affected site is submerged. An antiseptic and astringent agent like Triphala decoction may be added to the water if needed. A sitz bath soothes the skin and provides relief from pain. This also helps keep the area clean and thus reduces chances of infection.
  • Oily and spicy foods should be avoided: When dealing with Fistula, you should try and take a diet that keeps your stool soft and regular. Hence use of oily and spicy foods should be reduced. Eat plenty of fiber and drink lots of water. Alcohol should also be avoided. 

Ksharsutra vs Surgery in Fistula Patients-

  • Ksharsutra is done under Local Anesthesia. Hence complications of General Anesthesia are avoided. Surgical procedures are done under GA with all impending complications of General Anesthesia.
  • Ksharsutra being a parasurgical procedure hence no bleeding/ cutting of tissue is involved. Surgery involves cutting/ bleeding.
  • No hospitalization or bed rest is required in Ksharsutra Treatment. In Surgery hospitalization is must.
  • In Ksharsutra; patient can continue his normal daily routine.
  • Complications like incontinence (inability to hold stool) and recurrence are seen after surgery.
  • Ksharsutra is a safe procedure and these complications are not seen.
  • Ksharsutra Treatment is more economical as compared to VAAFT surgery. VAAFT Surgery is comparatively too expensive.

In case you have a concern or query you can always consult with us & get answers to your questions!

Read about: Painful Piles – Why You Should Not Ignore Them?

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