Anal fistula a challenge for modern surgery but curable by grade kshar-sutra in Ayurveda (Indian system of medicine).

Anal fistula is a disease for which differentmethods of treatment have been advocated time to time, Even today when we aretalking about robotic surgery, this disease has no satisfactory method oftreatment in modern surgery. The latest method of video assisted anal fistulatreatment (VAFT) is not satisfactory due to high incidences of recurrence afterthe surgery. But we at sushruta ano-rectal institute new delhi are successfullytreating all these complex anal fistulae without surgery  & with the help of graded ksharsutra(healingthread for fistula-in-ano) developed from ayurveda.

In Ayurveda about 2000yrs ago Acharya Sushruta hasindicated kshar sutra treatment to treat fistula-in-ano. Late professor P J Deshpandeyat faculty of Ayurveda Institute of Medical Sciences B H U, had done extensiveresearch in this field and established a treatment module to cure this disease.In 1990 Indian council of medical research has clinically evaluated thisayurvedic treatment module at four premiere institutes in our country includingAIIMS Delhi & P G I Chandigarh . Subsequently it was concluded by I.C.M.R.that in the patients of fistula in ano, ksharsutra treatment is more effective& convenient as compared to modern surgery.

Ksharsutra is a thred coated with certain ayurvedicmedicines known for their antiseptic, debridement & healing properties. Afteru v sterilization this medicated thread (ksharsutra) is used under completeaseptic precautions in the patients. The patient is routinely investigated withspecial reference to any other associated disorder like hypertension, diabetesmellitus, tuberculosis etc. The next step lies In the proper identification& evaluation of the fistulous tract. It is mandatory todefine the fistula tract wrt its depth, direction & branching pattern. Thismay be achieved by careful probing under expert hands using malleable probes& if required help may be taken from other investigations like x rayfistulogram or mri fistulogram. Once the tract has been clearly defined theksharsutra is placed in it with the help of certain instruments, under local anesthesia.This entire procedure is usually completed in ten to fifteen mins. As there isno cutting of tissues hence no bleeding, no pain & patients can go homeafter half an hr rest in the day care room. The medicine coated on the threadis gradually released in the tract.The cumulative effect of the coated drugs exerts a powerful debridement effecton the fistula tract & induces healing by the fresh & healthygranulation tissues. Thus kshara sutra is the mechanism of drug deliveryprecisely at the tissues involved. Every seventh ortenth day the old sutra is replaced with a new KSutra till there is a finalecut through. It has beenobserved that the tract heals @ 0.5-1 cm per week. The postoperativecomplications like recurrence of the disease, fecal incontinence, bleeding isnot seen with kshara sutra treatment. Further this therapy is performed as anOPD procedure. No generalanesthesia & no hospitalization is required.Patientmaintains his normal routine activities as usual during treatment period.  

 At sushrutaano-rectal institute we have been working on this disease including pilesfissures & pilonidal sinus for the last 15 yrs. Here we have developed theconcept of graded kshar- sutra which has given us a more efeective &convenient way to treat anal fistula. on record At sushruta ano-recta[institute instituteswe have treated thousands of patients of anal fistula from different statesincuding overseas patients. We have records to prove that the patients of highanal complex fistula, those have been operated two or three times but failed toheal were successfully cured at this institute.

                   Dr s k singh (gold medalist)

                           M S (ayurveda) B.H.U.