High anal fistula, an ano rectal disorder usually results to a sequel to some variety of ano rectal abscesses. This problem is challenging task to surgeons and available surgical procedures like fistulotomy and fistulectomy not only results with incontinence and even recurrences (26.5%) are established. The surgical procedures not only makes the patients to undergo a painful pre-operative and post operative procedures, but also results into a number of complications like infection, stenosis, retention of urine and bleeding. Keeping these disadvantages, a unique procedure of Ksharasutra (a medicated alkaline thread or chemical Seton) was advocated by Susrutha (800B.C), the father of ancient Indian surgery. In this connection an attempt has been made to establish the Ksarasutra’s efficacy in high anal fistula with a histo pathological evaluation and as well as to assess the nature of wound healing along with unit cutting time. In the present study Ksarasutra application in high anal fistula is compared with the application of non-medical thread / plane seton on 30 patients for Clinico Histopathological assessment.
1. To establish the superiority of Ksarasutra with non-medicated thread (plane Seton) along with histo – pathological evaluation.
2. To assess tissue changes and their wound healing properties clinically in both the groups.
Description of the technique and its method of application:
Ksarasutra (A medical alkaline thread impregnated with the paste of Turmeric Powder, the latex of Euphorbia nerefolia and the alkaline substance of Achyranthes aspera linn) is a well established procedure in the management of fistula-in-ano. After taking all aseptic precautions under spinal anesthesia or General anesthesia a malleable probe is facilitated through the fistulae track and thus applied with ksharasutra taking the Goodsall’s rule into consideration.
Slow and gradual cutting with simultaneous healing and total destruction of cryptic glands with a better drainage are the highlights of this technique. This procedure allows invisible minor tracks to drain into the major track by healing themselves totally before the major track is cut-off with Ksarasutra is probably the secret of success. The technique of Ksarasutra produces ‘Chemical Fistulecotmy’ which includes wound healing unlike ‘Physical fistulectomy’. This unified action of the medicated thread has been endorsed by the histopathological evaluation showing the fistula track with ksarasutra was with full epitheliazation with hyperplasia where as in non-medicated group even on the 28th day, healing was still lagging behind the epithelialization. The clinical assessment on 28th day in Group A reveals that scab over the wound was falling off spontaneously with healthy healing and where as in Group B the scab was not at all separated with unhealthy healing. All the results subjected for statistical analysis with linear regression method with significant at 1% (R2 value 0.7131).
The technique of ksarasutra therefore constitutes not only unique drug formulation procedures but also renders a novel method of drug delivery system on the fistular track and found to be superior with no proven side effects.
Role of Ksarasutra Management in High Anal Fistula With a Histo-pathological Study