Wednesday, November 28, 2018

Different treatment options in patients of anal Fistula!!!

Different treatment options in patients of anal Fistula!!!

Till date many treatments have been tried to cure Anal Fistula with different effectiveness.Most common treatment options are as below:

  1. 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. Complicationin 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. Kshar Sutra Treatment: It has been proved to be highly effective treatment for Anal fistula. Clinical trials were 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 Ano Rectal Institute; New Delhi) the chances of recurrence after Kshar Sutra treatment are predictably zero. 

Kshar Sutra 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/ VAAFT 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 sphincteric/ horse shoe shaped multiple tracts).

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Unethical (Bengali/ Madrasi) Treatment in Anal Fistula!!

Unethical (Bengali/ Madrasi) Treatment in Anal Fistula!!

At many places it can be seen that unqualified doctors make tall claims about treating anal fistula. The treatment; they are offering is associated with lot of complications and the procedure is not scientifically validated hence should be avoided.Please consult only qualified specialist doctor.

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Best Treatment for Anal Fistula!!

Best Treatment for Anal Fistula!!

Till date; many treatment options have been tried in the patients of anal fistula with different effectiveness. Among these most popular treatments are Fistulectomy (to cut out the fistula) Cutting seton (Ligating the fistula tract with a suture material facilitating easy discharge); Fibrin Glu insertion (insertion of bio- degradable glu in Fistula tract); VAAFT (Video Assisted Anal Fistula Treatment) etc.

All these treatment options have been associated with high incidence of recurrence (up to 25%). So none of them seems to be a good choice for Anal Fistula treatment. Whereas Ksharsutra treatment assures complete treatment with negligible chances of recurrence. Complications like incontinence, bleeding, pain are also not seen.This is a clinically proven method of treatment and suggested to be a better option than surgery by Indian Council for Medical Research; New Delhi.

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Sunday, November 11, 2018

5 things you should know about Anal Fistula!!

Anal fistula is a condition where a nodular swelling appears in area surrounding the anal opening. Intermittent pus discharged is noticed from this nodular swelling. An anal abscess is one of the most common causes for this condition. 

Here are five things you should know about anal fistula:

  1. It is curable through Ayurveda only: Till date many treatment options are tried to cure Anal Fistula which include Anal Fistula Surgery/ Glu technique/ cutting seton/ Colostomy/ Fistula plug/ VAAFT and many more.But all of these treatment methods have pretty high recurrence rate of about 20-25 %. However with Kshar Sutra treatment for Anal Fistula; chances of recurrence are negligible.Other complications generally seen in surgery like bleeding, incontinence (inability to hold stool); are not seen with Kshar Sutra Treatment. Clinical trials conducted by Indian Council for Medical Research (ICMR); at AIIMS New Delhi and PGI Chandigarh in 1992 have proved that Ksharsutra treatment is more convenient and more effective than Surgery in the patients of Anal Fistula.
  2. Medication can only provide temporary relief: Antibiotics and painkiller might give temporary relief from the symptoms. But after some time there will be again pus formation and associated swelling & pain in area surrounding anal opening.
  3. Anal fistulas can recur after surgical treatment: As discussed above all the treatment options tried by modern medicine (including most recent treatment VAAFT) have high incidence of recurrence (about 20- 25%) Whereas there are negligible chances of recurrence after Ksharsutra Treatment for Anal Fistula. .
  4. Anal fistulas treated by Graded Ksharsutra do not recur: Ayurvedic treatment for anal fistulas is known as Kshar sutra therapy. This involves the use of medicated thread being ligated in Fistula Tract. The medicines present in this thread act as a strong debriding agent and induces healing of Fistula tract. In few weekly sittings of Ksharsutra change Fistula gets healed completely and it do not recur. Patient maintains his normal routine life during treatment period. 
  5. Sitz bath can be beneficial: This involves sitting in a tub filled with warm water so that the affected site is submerged. An antiseptic and astringent agent like Triphala decoction may be added to the water if needed. A sitz bath soothes the skin and provides relief from pain.This also helps keep the area clean and thus reduces chances of infection.
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Is Surgery the Only Treatment for Anal fistula?

Is Surgery the Only Treatment for Anal fistula?

No! Not at all!!
Treatment of choice for a disease is that which cures the disease completely and there is no complication associated with the treatment.
Generally Surgery is recommended for Anal Fistula. But there are many complications in Surgery for Anal
Fistula like

  1. Incontinence (inability to hold stool); Damage done to the anal sphincter muscle during surgery leads to inability to hold the stool.Leakage of Stools is especially prominent during loose motion.
  2. Recurrence of Fistula –In about 25% of cases recurrence has been reported after surgery/ VAAFT.
  3. Surgery is done under general Anesthesia so complications associated with General anesthesia are also involved.
  4. Daily routine is also hampered in Surgery for Anal fistula as hospitalization followed by bed rest is necessary.
Whereas in Ksharsutra treatment for Anal Fistula
  1. There are negligible chances of recurrence;
  2. Incontinence is never observed.
  3. Kshar Sutra treatment is done under Local Anesthesia; which is the safer than General Anesthesia
  4. No hospitalization or bed rest is necessary in Ksharsutra treatment. Patient can continue his normal daily routine as usual.
Clinical trials conducted by Indian Council for Medical Research at AIIMS Delhi; PGI Chandigarh etc. have concluded that Ksharsutra Treatment is more effective and convenient as compared to surgery in the patients of Anal Fistula.
Therefore Surgery is not a good choice for Anal Fistula treatment Kshar Sutra treatment should be preferred for the reasons explained above.

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Every disease related to Anus is Piles!! Myth or Fact ?

Every disease related to Anus is Piles!! 

Myth or Fact ?

This is a Myth!!
Piles is a very common Disease seen in anal region. Apart from Piles.other common diseases seen in anal region are Fissure, Fistula, Prolapse rectum, Anal Polyp,Perianal abscess etc.
Therefore pain and bleeding in anal region do not indicate only
piles. It should be properly examined, diagnosed and treated
by a qualified doctor.

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