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Fistula in Ano: A Modified Approach - A Case Report

Management of fistula is one the most notorious job for the surgeon because of its ill site, chronicity, and recurrences. Treatment modalities like anal fistula plug, mucosal flap advancement, fibrin glue, and VAAFT (Video Assisted Anal Fistula Treatment) are there but ksharsutra has edge on them for its success rate and non-recurrence. Even after its better results, weekly sitting and pain during changing of ksharsutra and discomfort of ksharsutra being in situ makes it difficult for patient to pursue the treatment. Hence, a new approach was mandatory. Considering fistula to be a dushtavrana, shashti upakrama like lekhan, shodhan and ropan were applied in a patient of high-anal transphincteric fistula. Partial fistulectomy, excessive curettage (lekhan) from its internal opening was done. Internal opening was closed and wound was allowed to heal by second intension with the help of shodhan and ropan tail. Post-operative antibiotics and anti-inflammatory were given. It was observed that wound healed at good rate without discomfort of patient in 25 days. It underlines importance of shashtiupkrama in modern age of surgery also.