Tuesday, November 15, 2016

Anal Fistula Now Can Be treated Without Surgery

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

Anal fistula is a disease for which different methods of treatment have been advocated time to time, Even today when we are talking about robotic surgery, this disease has no satisfactory method of treatment in modern surgery. The latest method of video assisted anal fistula treatment (VAAFT) is not satisfactory due to high incidences of recurrence after the surgery.
But we at Sushruta Anorectal Institute new Delhi are successfully treating all these complex anal fistulae without surgery  & with the help of graded Ksharsutra (healing thread for fistula-in-ano) developed from Ayurveda.

In Ayurveda about 2000 yrs ago Acharya Sushruta has indicated Ksharsutra treatment to treat fistula-in-ano. Late professor P J Deshpandeyat faculty of Ayurveda Institute of Medical Sciences B H U, had done extensive research in this field and established a treatment module to treat this disease.In 1990 Indian council of medical research has clinically evaluated this Ayurvedic treatment module at four premiere institutes in our country including AIIMS 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 thread coated with certain Ayurvedic medicines known for their antiseptic, debridement & healing properties. After u v sterilization this medicated thread (Ksharsutra) is used under entirely aseptic precautions in the patients. The patient is routinely investigated with special reference to any other associated disorder like hypertension, diabetes mellitus, tuberculosis etc. The next step lies In the proper identification& evaluation of the fistulous tract. It is mandatory to define the fistula tract wrt its depth, direction & branching pattern. This may be achieved by careful probing under expert hands using malleable probes& if required help may be taken from other investigations like x ray, fistulogram or MRI fistulogram. Once the tract has been clearly defined the Ksharsutra is placed in it with the help of certain instruments, under local anesthesia.This entire procedure usually takes ten to fifteen mins. As there is no cutting of tissues hence no bleeding, no pain & patients can go home after half an hr rest in the day care room. The medicine coated on the thread is gradually released in the tract.

The cumulative effect of the coated drugs exerts a powerful debridement effect on the fistula tract & induces healing by the fresh & healthy granulation tissues. Thus Ksharsutra is the mechanism of drug delivery precisely at the tissues involved. Every seventh or tenth day the old sutra is replaced with a new Kshsrsutra till there is a finale cut through. It has been observed that the tract heals @ 0.5-1 cm per week. The postoperative complications like recurrence of the disease, fecal incontinence, bleeding is not seen with Ksharasutra treatment. Further this therapy is performed as an OPD procedure. No general anesthesia & no hospitalization is required. Patient maintains his normal routine activities as usual during treatment period.  

At Sushruta Anorectal Institute we have been working on this disease including piles fissures & pilonidal sinus for the last 15 yrs. Here we have developed the concept of graded Ksharsutra which has given us a more effective & convenient way to treat anal fistula. on record At Sushruta Anorectal Institute we have treated thousands of patients of anal fistula from different states including overseas patients. We have records to prove that the patients of high anal complex fistula, those have been operated two or three times but failed to heal were successfully treated at this institute.