Trans-Sphincteric Horseshoe Anal Fistula Managed with Interception of Fistulous Tract with Application of Ksharasutra (IFTAK) procedure: clinical outcomes and benefits: A Case Report

Abstract

The management of complex anal fistula presents a significant challenge to surgeons due to high recurrence rates and complications such as sphincter injury. Ksharasutra therapy is a well-established treatment modality for managing fistula-in-ano; however, it has certain limitations, including prolonged treatment duration, the need for frequent hospital visits for dressing, and pain during Ksharasutra change. A 42 year old male patient presented with pus discharge from perianal area and pruritis was diagnosed as posterior horseshoe trans-sphincteric anal fistula through clinical examination and ultrasonography findings. it was successfully managed through the principle of Interception of Fistulous Tract with Application of Ksharasutra (IFTAK). Following an initial course of antibiotics and analgesics, the patient was transitioned to Ayurvedic oral medications. Postoperative pain was minimal, with a gradual reduction in pus drainage, and complete wound healing was achieved in less than two months, with a cosmetically acceptable scar. A follow-up period of 10 months revealed no recurrence. The IFTAK technique, a modified form of conventional Ksharasutra therapy, significantly reduces healing time by precisely targeting the source of infection while minimizing postoperative scarring. Proper postoperative wound assessment and care are critical to the success of the treatment.