Minimising the time consumption with Ksharasutra therapy in the management of Bhagandara (anal fistula)- Case Series of two Patients

Abstract

Ksharasutra therapy in Bhagandara (Anal Fistula) is time tested and has been successfully practicing across India for the last 50 years as well as in western countries like Japan. It is very accepted among modern medicine surgeons because of its beauty of non-recurrence, simplicity, healing with little scar and cost effectiveness and it is advised to those who are unfit for surgery and anaesthesia. Though there were positive points, a few negative points were also in practice. Time conception is the major issue. Two to three months of time for the Ksharasutra therapy is a problem in this modern fast world, to minimize the treatment duration we are forced to think for an alternative method without avoiding Ksharasutra. The root cause of anal fistula is the infection of crypto glands, from where it spreads to inter sphincteric area or other spreading roots. Since the source of infection is crypto glands its removal was the target. Hence a plan to target the infected crypto glands and cauterizing chemically with the effect of Kshara present in Ksharasutra has been executed. For that window technique by using Ksharasutra at the source of infection (crypto glands) is tried in this case series of two patients. A Ksharasutra was ligated, thereafter using the probe.This was then changed every seventh day till it cut through. Everyday a piece of Ksharasutrawas inserted through the external opening to minimize the thickness of fibrous lining of the tract. Both the cases were completely cured. Case no 1cured after 35 days and Case no 2 cured after one month and follow up every fortnightly for two months found no recurrence.