A small channel that forms between the skin surrounding the anus and the end of the bowel is called an anal fistula (Bhagandar / Fistula in ano). It is often the consequence of an anal abscess, either previous or current. A fistula’s tract has two openings: an external opening through the buttocks’ skin and an internal opening into the rectum or anal canal.
Anal Fistula Treatment
In rare cases, anal fistulas heal on their own. Moreover, oral medications are ineffective in treating fistula in ano. Now let’s examine the available treatment options to learn how to cure a persistent anal fistula effectively.
Treatment options for fistula
Seton: A non-absorbable suture made of silk or nylon is placed into the fistula tract. The primary objective of seton therapy is to maintain the tract patent, allowing for easy pus discharge and minimizing pain and swelling in the patient. Cutting seton is also employed as an alternative. In the hopes that by cutting the intervening tissue, the seton will eventually heal the fistula without the need for surgery. Seton is tightened at regular intervals to induce pressure necrosis, or tissue death.
| Advantages of Seton | Disadvantages of Seton |
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Fistulotomy and lay open technique: This procedure involves dividing the surrounding tissue with a knife after a probe is inserted through the fistula tract. Fistula is laid open and treated as an open wound.
| Advantages of Fistulotomy and lay open technique | Disadvantages of Fistulotomy and lay open technique |
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Fistulectomy with primary sphincter reconstruction: This procedure involves making an incision from the internal opening to the edge of the anal cavity. The external opening is then removed, or cut out, from that point. Once the external sphincter muscles are reached, the fistula tract is removed.
| Advantages of Fistulectomy with primary sphincter reconstruction | Disadvantages of Fistulectomy with primary sphincter reconstruction |
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Fibrin Sealant: The tract is first debrided in this treatment. To further clean the tract after debridement, saline or hydrogen peroxide irrigation is used. At the internal opening, the sealant is gradually injected and given time to solidify. The sealant is injected to completely destroy the tract after the clot has stabilized at the main opening. For five to ten minutes, the clot is left to solidify.
| Advantages of Fibrin Sealant | Disadvantages of Fibrin Sealant |
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Fistula Plug: The fistula tract is identified using a standard fistula probe, and curettage is then performed. The plug can be tied to the probe and pulled through the tract after the probe has been inserted. The plug is internally trimmed to the level of the mucosa and secured with an absorbable suture. The plug’s exterior end is also cut at the skin’s level. Since it is recommended that some space be left at the exterior opening to permit tract drainage, the plug is not sewed distally. The type of fistula plug can be either synthetic or biological, depending on the material used.
| Advantages of Fistula Plug | Disadvantages of Fistula Plug |
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Advancement flap: This procedure involves visualizing the internal opening and probing the fistula tract. It is important to identify any additional tracts carefully because undrained tracts can cause the flap to fail. A flap of partial thickness is raised, starting from below and ending at the internal opening. To ensure sufficient blood supply to the flap, the width of the flap is gradually increased during development until the base of the flap is at least twice as wide as the apex. The flap is dissected further until it passes through the internal opening without being overly taut. Granulation tissue and debris are removed from the fistula tract by curettage. The opening inside is sealed.
The internal opening is located at the tip of the flap, which is removed. After that, the flap is sewn in place. An endorectal advancement flap is what it is. A dermal advancement flap is created when skin is used as the flap and extended to the internal opening.
| Advantages of Advancement flap | Disadvantages of Advancement flap |
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Ligation of Intersphincteric Fistula Tract (LIFT): This medical procedure involves inserting the fistula probe first through the tract. Next is the identification of the fistula tract and the dissection of the groove formed by two sphincter muscles. A section of the fistula tract may be removed if it is very long after the fistula tract is divided and sutured both above and below. To aid in drainage, the external tract opening is enlarged and the LIFT wound is loosely closed.
| Advantages of Ligation of Intersphincteric Fistula Tract (LIFT) | Disadvantages of Ligation of Intersphincteric Fistula Tract (LIFT) |
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Video-Assisted Anal Fistula Therapy (VAAFT): In VAAFT, the tract is examined from the inside out using direct vision, similar to “putting an eye” on a probe. The internal opening is sealed, the fistula tract is cleaned, and any waste is removed.
| Advantages of Video-Assisted Anal Fistula Therapy (VAAFT) | Disadvantages of Video-Assisted Anal Fistula Therapy (VAAFT) |
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Fistula Laser Closure (FiLaC): A ceramic diode laser platform is used to carry out the FiLaC process. Until the internal orifice is located, the laser fiber is inserted into the fistula tract through the external orifice. The fistula tract surrounding the fiber contracts as a result of the fiber’s delivery of laser energy.
| Advantages of Fistula Laser Closure (FiLaC) | Disadvantages of Fistula Laser Closure (FiLaC) |
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Ksharsutra Treatment for Fistula: First, the fistula tract is defined by probing or an MRI fistulogram. Ksharsutra is inserted into the fistula tract with the use of an probe with an eye. Ksharsutra’s medicinal contents debride the fistula tract and promote internal healing. Since this medication only lasts for five to seven days, a new ksharsutra is applied every seven or ten days until the fistula heals completely.
| Advantages of Ksharsutra Treatment for Fistula | Disadvantages of Ksharsutra Treatment for Fistula |
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Can Ayurveda Cure Fistula-in-Ano?
As was previously mentioned, there have been a number of proposed treatments for anal fistula over the years. One can conclude that, indeed, Ayurveda is able to cure fistula after weighing the benefits and drawbacks of the top ten treatments currently available. Furthermore, the Ksharsutra Fistula Treatment is the only one that is currently available that assures full healing of the fistula without any complications, such as the inability to hold stool, which is a common side effect of fistula surgery.
What is Ksharsutra Treatment for Fistula
What is Ksharsutra
In the term Ksharsutra, Kshar refers to a specific type of alkaline ayurvedic medication made from the ashes of plants such as Apamarga, Yava, Til Naal, etc., and sutra means a thread. Ksharsutra is therefore a medicinal thread. This thread serves only as a means of administering medication at the intended location; it plays no part in the actual treatment process.
How Ksharsutra is prepared
The latex of Snuhi (Euphorbia neriifolia Linn), Apamarga Kshar (Kshar made from Apamarga – Achyranthes aspera), and Haridra (Curcuma longa) is applied to a linen thread to make Ksharsutra. These medications are individually coated on the thread in a total of twenty-one coatings. The prepared Ksharsutra is then sterilized using ultraviolet radiation.
Is Ksharsutra treatment approved by any government agency:
Yes, The Indian Council of Medical Research (ICMR) has granted clinical approval for the Ksharsutra Treatment for Fistula. This ayurvedic treatment module was clinically evaluated by the ICMR in 1991 at four of our nation’s top institutions, including PGI Chandigarh and AIIMS New Delhi. The ICMR subsequently concluded that, for patients with fistula-in-ano, Ksharsutra treatment is more convenient & more effective than contemporary surgery.
How Ksharsutra Treatment is done?
Ksharsutra Treatment procedure:
All standard tests are done prior to beginning Ksharsutra treatment. A Ksharsutra specialist places particular emphasis on the concurrent possibility of other diseases such as diabetes, hypertension, tuberculosis, ulcerative colitis, etc. during examinations. The fistulous tract must then be properly defined, paying particular attention to its length, depth, and branching pattern. Most of the time, all of these details can be obtained by probing with a soft, malleable metallic probe. An MRI fistulogram or ultrasound may be recommended by a Ksharsutra expert if the fistula is deep enough to be accurately defined by manual probing or if the branching pattern of the fistula is unclear.
The Ksharsutra expert inserts the Ksharsutra into the fistula tract through the external opening that emerges from the Anal opening after correctly defining the fistula tract through probing. The Ksharsutra’s two ends are then knotted by the expert. Ksharsutra’s medicinal contents debride the Fistula tract and promote healing. Since this medication only lasts for five to seven days, a new Ksharsutra is administered in place of the old one every week or ten days. The length, depth, and branching pattern of the fistula tract determine how many Ksharsutra changes are necessary for the fistula to heal completely.
Every time a ksharsutra is changed, it is customary to measure the ksharsutra’s length in order to gauge how well the patient is responding to treatment. Every ksharsutra change sitting, the fistula is observed to heal at a rate of 0.5 to 1 cm. Thus, four to six Ksharsutra change sittings per week or ten days might be necessary for a fistula tract measuring three centimeters in length.
Ksharsutra Treatment for Fistula at Piles To Smiles
Fistula Treatment in Delhi
There are various treatment modules that have been recommended for fistula-in-ano. Since there is no oral medication that can treat this illness, the only option left to us is fistula surgery. However, due to the fact that the fistula recurs after surgery or that complications from the surgery, such as the inability to hold stool, render all surgical treatment options for the fistula ineffective. For this reason, there is a saying in the medical community that goes, “If you want to disrepute a surgeon, send him fistula patients.”
In this scenario, Ksharsutra treatment for fistula emerges as a ray of hope for fistula patients because it ensures complete healing of the fistula without complications. At Piles To Smiles, Ksharsutra Treatment is the only method used to treat fistulas in Delhi. A specialized medicated thread called a Ksharsutra is ligated in the fistula tract during this treatment. The Ksharsutra is changed every week until the fistula heals fully. There is no need for hospitalization or bed rest for this treatment because it is administered under local anesthesia. Throughout treatment, the patient can carry on with his regular activities. At Piles To Smiles, we successfully treat fistulas with the Ksharsutra Treatment, yielding 100% positive outcomes.
- Seyfried S, Bussen D, Joos A, Galata C, Weiss C, Herold A. Fistulectomy with primary sphincter reconstruction. Int J Colorectal Dis. 2018 Jul;33(7):911-918. doi: 10.1007/s00384-018-3042-6. Epub 2018 Apr 12. PMID: 29651553.
- https://www.medscape.com/answers/190234-82310/what-is-the-efficacy-of-seton-placement-for-the-treatment-of-fistula-in-ano-anal-fistula
- https://link.springer.com/chapter/10.1007/978-1-4614-9014-2_9
- Maralcan G, Başkonuş I, Gökalp A, Borazan E, Balk A. Long-term results in the treatment of fistula-in-ano with fibrin glue: a prospective study. J Korean Surg Soc. 2011;81(3):169-175. doi:10.4174/jkss.2011.81.3.169
- Limura E, Giordano P. Modern management of anal fistula. World J Gastroenterol. 2015;21(1):12-20. doi:10.3748/wjg.v21.i1.12
- Bleier JI, Moloo H, Goldberg SM. Ligation of the intersphincteric fistula tract: an effective new technique for complex fistulas. Dis Colon Rectum. 2010 Jan;53(1):43-6. doi: 10.1007/DCR.0b013e3181bb869f. PMID: 20010349.
- Dr., P.S., & Prof., M.S. (2010). Efficacy of Kshar Sutra (medicated seton) therapy in the management of Fistula-in-Ano. World Journal of Colorectal surgery, 2, 6.
FAQs
Since local anesthesia is used during the Ksharsutra Treatment for Fistula, you will likely be awake and able to communicate with your doctor! The only pain you will experience is a few pinpricks from the local anesthetic used at the beginning of the process. The entire process takes fifteen to twenty minutes.
Usually, you can resume eating and drinking right after the procedure. You’ll be able to move around and get out of bed.
Following the procedure, you might experience some pain, but this can be managed easily with painkillers.
No hospital stay or bed rest is necessary because the Ksharsutra Treatment for Fistula is performed under local anesthesia. After taking the oral medications as directed and passing urination, you will be discharged from the hospital in two to four hours. A responsible adult should take you home and stay with you for the next 24 hours, if possible.
Painkillers, laxatives, and post-operative care will be discussed with you prior to your discharge.
No particular diet is required of you. Just remember to consume a balanced, high-fiber diet both before and during the Fistula Ksharsutra Treatment.
Be as active as you can; during Ksharsutra Therapy for Fistula, it is recommended to walk for three to four kilometers every day, take Sitz baths roughly three times a day (especially after a bowel movement), practice good hygiene, and eat a diet high in fiber.
Beginning on the first day of the Ksharsutra Fistula Treatment, you can commence travel.
There is no need for a special pillow during Ksharsutra Fistula Treatment.
It is dependent upon the Fistula tracts’ length, depth, and branching arrangement. Fistulas heal at a rate of 0.5 to 1 cm for every weekly Ksharsutra change. It may thus take 4-6 weeks for a 3 cm fistula tract to fully heal.
- Pain not alleviated by prescribed medications;
- Fever exceeding 101 degrees F
- Unusual bleeding during bowel movements; •
- Prolonged nausea or vomiting
