Fistula in ano is a chronic abnormal communication between the epithelialised surface of anal canal or rectum and usually the perianal skin or it can be described as a narrow tunnel with its internal opening in the anal canal or rectum and external opening in the skin around the anus. History of Fistula in Ano: The great ancient Indian surgeon Acharya Sushruta (6th century B.C.) narrated in his teachings about this disease with the name of Bhagandara and its treatment by different means. The term fistula is derived from a Latin word meaning pipe. Keeping in mind the high recurrence rate of the disease, we prefer to manage the disease with Kshara Sutra therapy. Kshara Sutra is changed after an interval of seven to ten days till the patient gets recovered.

Fistula in ano is a chronic abnormal communication between the epithelialised surface of anal canal or rectum and usually the perianal skin or it can be described as a narrow tunnel with its internal opening in the anal canal or rectum and external opening in the skin around the anus. DAV Hospital provides specialised fistula treatment for moderate to severe cases.

History of Fistula in Ano: The great ancient Indian surgeon Acharya Sushruta (6th century B.C.) narrated in his teachings about this disease with the name of Bhagandara and its treatment by different means.

The term fistula is derived from a Latin word meaning pipe.

Keeping in mind the high recurrence rate of the disease, we prefer to manage the disease with Kshara Sutra therapy. Kshara Sutra is changed after an interval of seven to ten days till the patient gets recovered.

What causes Fistula In Ano

•          Inflammed and infected condition of the anal glands and anal crypts–Cryptoglandular - 90%

•          Non Cryptoglandular (others) - 10%

Features

•          Patients have complaint of Seropurulent/Purulent discharge around the anus.

•          Skin irritation around the anus.

•          One or more external openings around the anus.

•          It may heal superficially but pus may collect beneath forming an abscess which again discharges through the same or new opening.

How to Diagnose Fistula in Ano

•          From the history of the patient

•          After examining the patient

•          Probing the fistula track under anaesthesia.

•          Fistulography

•          USG pelvis

•          MRI is the best investigation but is expensive to patient and is very useful in complicated fistula.

Management

Goals of management

•          Drain local infection

•          Eradicate fistula tract

•          Avoid recurrence while preserving native sphincter function.

Post Kshara Sutra Therapy Instructions

•          Patients are allowed to take orally liquid diet after 3  hours of operation and semi-solid diet or solid diet from the next day.

•          From next morning, warm Panch valkal kwath sitz bath are advised atleast thrice a day.

•          Tablet triphala guggulu 2 tablets BD.

            Haritaki churna 5 to 10 gms OD at bed time  with warm water.

•          Jatyadi oil matravasti 5 ml,  twice a day.

•          If pain is there some suitable analgesics  are prescribed.

•          Antibiotics are generally avoided.

Precautions/Prohibitions

•          To be ambulatory during the period of treatment.

•          To take normal diet daily and avoid spicy foods

•          To avoid constipation, drink plenty of water  and take fiber rich diet.

•          To keep the bowel clear regularly by taking suitable and mild laxative.

•          To avoid prolonged sitting as well as standing during the course of treatment.

•          Keep the anal region clean, do proper dressings.

 

•          It is an out patient treatment.

•          Minimal hospital stay.

•          Minimal bed rest after the procedure.

•          Minimal invasive therapy

•          Patient can resume his/her daily routine with in three to five days.

•          No complications lie incontinence, deformity and  stricture.

•          Patients remain ambulatory during the course of the treatment.

•          The recurrence rate of the fistula in ano is very less after kshara sutra therapy.

Case Report

Patient name: S. Joginder Singh

Age: 55 Male

OPD No.: 11661/1480

Mob.: 9478536077

Address: Vill. Ranipur, Teh.: Phagwara, Distt. Kapurthala

Occupation: Agriculturist

Symptoms: Complaint of slight pain, swelling, pus discharge and difficulty in sitting from last about 8 months.

History of previous treatment taken: Patient took various medications from different hospitals and couldn't found any significant improvement

Patient had history of surgery at Phagwara about 8 to 9 month back

On Examination:

Inspection

•          Scar mark of previous surgery seen around left perianal region.

•          Three external openings seen around left perianal region.

Palpation:

•          Tenderness +ve around left perianal region.

•          Expression of pus from all the openings.

DRE: Tenderness +ve midline posteriorly (6 o clock position)

Investigation: CEMR Fistulogram dated 3/6/15

Blood investigation: Normal

Diagnosis: Recurrent Fistula in Ano.

Date of Procedure:16/6/2015

Procedure: Multiple Kshara Sutra application done under local anaesthesia

Follow up: Kshara Sutra changed after an interval of 7 to 10 days till the patient got full recovery.