Long-term Recurrence-Free Outcome with IFTAK in an Inter-Sphincteric Fistula with Blind Branch: A Case Report

Abstract

Long-term follow-up is essential to assess the recurrence of fistula following any therapeutic or surgical intervention. Anal fistula with blind extensions poses diagnostic and therapeutic challenges, with higher recurrence risk if inadequately managed. Interception of fistulous tract with Ksharasutra (IFTAK) offers a sphincter-preserving alternative with potentially faster healing. A 21-year-old male presented with a 4-month history of intermittent purulent discharge and discomfort. Examination and trans-rectal ultrasonography (TRUS) confirmed a low inter-sphincteric fistula with a blind branch. The patient underwent IFTAK, with Ksharasutra placed in the proximal tract and Ksharavarti in the distal tract. Postoperative care included oral administration of tab. Kanchanara Guggulu, Varunadi Kashaya, wound care with Triphala Kwatha and Jatyadi Taila till complete healing. The distal tract healed by day 25, complete wound healing occurred by day 58, continence was preserved, and no recurrence occurred during 20-month follow-up. No adverse drug reactions were noted. IFTAK provided effective, sphincter-preserving management with durable long-term results in an inter-sphincteric fistula with a blind branch.