Fistula Management

Management of fistula-in-Ano with 
Kshar Sutra  Treatment

Management of Fistula-in-ano involves three main Karmas –

  • Purva karma
  • Pradhana karma
  • Paschata karma

Purva karma

  • Written informed consent of the patient and attendant.
  • Antitetanous as prophylaxis.
  • Xylocaine sensitivity test.
  • Shaving of the operation field and soap water enema should be given 12 hrs prior to operation.
  • Another soap water enema is given in the morning of operation day.

Pradhana karma

  • Position – Lithotomy
  • Preparation of the part
  • Types of anaesthesia
    • L.A.
    • Short term G.A.

Procedure of K.S. application

Step I

    • Suitable probe selection.
    • Anal canal is dilated and fistula track is explored with a probe by inserting through its distal opening (external opening) and index finger is introduced into the anal canal to locate the internal opening.
    • Probing negotiated and advanced gently along the path of least resistance.
    • Retrograde probing can also be done into an anal crypt, especially one with a nearby hypertrophied papilla.

Step II

    • A K.S. of suitable length and size is placed in the eye of probe and the probe is pulled out through anal orifice, in order to position the K.S. in the tract.
    • Both ends of the K.S. tied loosely outside the anal orifice.

Step III

    • Curettage of external opening to remove unhealthy granulation tissues sprouting from external opening and edges of the external opening of the tract can be trimmed.
    • Dressing of the wound with medicated oil.
    • Application of T- bandage.

Paschata Karma

  • Nill orally up to 3 hours.
  • Analgesics as and when required.
  • Shothahara drugs as guggulu.