Wednesday, February 22, 2017

Facts about Pilonidal Sinus

  1. Pilonidal sinus presents as a nodular swelling in lower spinal region with occasional discharge which might stain undergarments. Mild pain can also be there. Sometimes hairs can also be seen protruding out of this nodular swelling.
  2. Pilonidal sinus is usually seen in adults of college or school going age with hairy skin.
  3. Pilonidal consists of two words Pilus means hair + Nidus means nest i.e. hair nested in a cavity. It tells about the role of hairs in Pilonidal Sinus. The problem is more common in people with hairy skin.
  4. Though exact pathology of Pilonidal Sinus is not certain. It is believed that sharp ends of hairs prick in the skin and infection can invade from these holes and result in Pilonidal Sinus.
  5. Medicinal treatment is not successful in Pilonidal sinus. Oral medication Allopathic/ Homeopathic/ Ayurvedic whatever it may be; can give only temporary relief but do not eradicate the problem.
  6. As per surgeons surgical procedures like Z- plasty etc. are the only treatment for Pilonidal sinus. But in as high as 15 % cases Pilonidal Sinus recur even after surgery.
  7. Post operative pain, hospitalization/ bed rest and chances of recurrence are the factors which suggest that Surgery is not the appropriate choice for Pilonidal Sinus treatment.
  8. Ksharsutra treatment is recommended for pilonidal sinus in Ayurveda. No hospitalization or Bed rest is required in Ksharsutra treatment for Pilonidal Sinus.
  9. Predictably there is 0% recurrence after Ksharsutra treatment for Pilonidal Sinus.
  10. Pilonidal Sinus cannot be treated by any home remedy so instead of searching for Home Remedy for Pilonidal Sinus; plan for treatment i.e. Ksharsutra treatment for Pilonidal Sinus as soon as possible.
To know more about Ksharsutra Treatment for Pilonidal Sinus check:

Top 10 Treatments for Fistula

1. Lay-open of fistula-in-ano: In this procedure; an operation is carried to cut the fistula open. After that it is regularly packed on daily basis to ensure proper healing of wound. It lefts behind a scar tissue and depending upon location of Fistula in relation to sphincter muscles there might be some risk of stool incontinence and if it is not healed properly; there are chances of recurrence.

2. Cutting seton: This treatment involves inserting a tube in fistula tract and tying it outside the body. Seton is tightened on regular basis to ensure cutting the fistula tract. So it is the tightened seton which causes cutting of tract. This procedure might involve too much pain and in some cases there might be incontinence especially of flatus.

3. Fistulectomy: It is surgical procedure where whole Fistula tract is excised (cut out). In certain cases; there might be more than 1 surgery. Recurrence of fistula and stool incontinence are the possible post treatment complications.

4. Colostomy: In this procedure; an opening is made by drawing part of colon through an opening to anterior wall of abdomen. A Stoma appliance is fixed to this opening to make an alternate way for stool to leave the body. This procedure is done to avoid contact of fecal matter with Fistula assuming that it will lessen the chances of infection and fistula will heal easily. Along with recurrence of fistula and incontinence there are certain other complications in this procedure like formation of hernia near Stoma opening, Stomal blockage; another fistula formation near Stomal opening etc.

5. Fibrin glue injection: In this procedure; bio degradable glue is injected in the fistula tract which is supposed to close the fistula and let it heal naturally. Recurrence rate in Fibrin glue injection is as high as 30-35%;

6. Fistula plug: This treatment involves plugging the fistula tract from inside with a plug made up of intestinal tissue. Complication in this treatment involves treatment failure, plug extrusion, abscess at the site of plug etc.

7. Endorectal advancement flap: In this procedure; internal opening of Fistula is identified and a mucosal flap is cut around the opening and opening is closed with this flap. After that external opening is cleaned and sutured. The main complications in this treatment are failure of treatment and recurrence of fistula.

8. LIFT Technique: Ligation of Intersphincteric Fistula tract procedure; involves closure of internal opening of Fistula tract and removal of infected tissue. Recurrence of Fistula is the main complication in LIFT procedure.

9. VAAFT: Video Assisted Anal Fistula Treatment; with fistuloscope fistula tract is visualized and location of internal opening is confirmed. After that internal opening is closed using stapler or flap made from a layer of skin and internal layer of intestine. Disadvantages of VAAFT include reopening of internal opening leading to failure of treatment and recurrence of fistula.

10. Ksharsutra Treatment: It has been proved to be highly effective treatment for Anal fistula. A Clinical trial was conducted by Indian Council of Medical Research (ICMR) in 1991 at various medical institute including All India Institute of Medical Sciences (AIIMS) New Delhi and PGI Chandigarh etc. to see the effectiveness of Ksharsutra Treatment. It was concluded that Ksharsutra treatment is more effective and more convenient as compared to surgery in the patient of Anal Fistula. With the latest concept of Graded Ksharsutra (Sushruta Anorectal Institute; New Delhi) the chances of recurrence after Ksharsutra treatment are predictably zero.

Ksharsutra is a medicated thread which is prepared by coating of certain herbal latex with herbomineral powders. The thread is alkaline in nature and it has highly selective debridement property. The fistulous tract is properly defined using MRI fistulogram or clinical probing and then with the help of certain instruments; the thread is placed in the fistulous tract. The medicine is gradually released in the tract from the thread and do the necessary debridement of fistulous tract. The thread is changed at weekly interval till there is a final cut through and the tract has healed. So here it is the medicine which debrides the fistula and ensure healing. Thread is just working as a vehicle for drug delivery in Fistula Tract. The anal fistula patient in whom fistula has recurred after Fistulectomy/ Colostomy/ Glue/ MAFT/ VAFT; these patients have been successfully treated by Graded Ksharsutra. The treatment is equally effective in the case of complex high anal fistula (Supra levator/ trans sphincterric/ horse shoe shaped multiple tracts).

For more details about Ksharsutra treatment for