A CASE STUDY ON A COMPLEX FISTULA-IN-ANO BY AYURVEDIC MANAGEMENT

Abstract

Fistula-in-ano can be a complicated disease to manage. An anal fistula is divided into simple and complex fistula. Managing complex fistula is even more challenging, which typically affects younger people and causes persistent morbidity. It is pertinent to define complex anal fistula. From a practical point of view, a fistula that is difficult to manage has a higher risk of recurrence, poses a greater threat to continence and is classified as a complex fistula. Due to its difficulty in treating medically and surgically, Bhagandara (fistula-in-ano) is one of the eight major disorders classified under Astamahagada in Ayurveda. Ayurvedic surgeons frequently use the effective fistula treatment known as Ksharasutra; however, cutting the passage takes a very long time. As a result, this procedure is now sometimes referred to as partial fistulectomy with Ksharasutra ligation, fibrin glue, fistula plug (FP), Fistula-tract Laser Closure (FiLaC), Seton techniques, video-assisted anal fistula treatment (VAAFT), LIFT (ligation of intersphincteric fistulous tract), and IFTAK (interception of fistulous tract with application of Ksharasutra), also known as window technique, where the Guggulu based Apamarg Ksharasutra is placed. This method shortens the healing time and allows repairing such a complicated fistula-in-ano with little tissue injury. Infected anal crypt, secondary extension and related conditions are the key factors that lead to the recurrence of complex anal fistulas. Surgery in complex anal fistula aims to prevent recurrence, avoid incontinence and avoid damaging the sphincter muscles (the ring of muscles that open and close the anus).