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 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.
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)