I would like to share a case of small fistula-in- ano in a 40-year old male. It had a short history for six months. The patient had been suffering from pain and burning sensation in anus for two years which was treated conservatively at home with home remedies. Suddenly he developed a painful perianal swelling which, I suppose, was a perianal abscess. It was drained spontaneously after two days, since then the discharging wound did not heal up. The patient visited a local doctor who told him about anal fistula. The conscious patient immediately explored internet and came to know about ksharasutra – its merit, procedure and all other relevant information. I did one-hour counselling as usual giving all possible details of the procedure.
It was a low anal fistula with external opening at 6 O’ clock position and internal opening alsoat 6 O’ clock position on fissure bed at posterior midline (fig.1). This was a small fistula which could have been successfully treated with two stage setonfistulotomy, but I treatedwith ksharasutra as patient preferred it.
I placed a ksharasutra and a draining seton (monofilament)separately.In this case the ksharasutra was just entangling the internal anal sphincter (IAS). Contrary from the common method, I preferred to place ksharasutra loosely and the monofilament tightly. The monofilament caused fibrosis of IASand the ksharasutradestroyed and removed unhealthy tissue. It facilitated in drainage of pus in fistulous tract and also promoted healing of the fistulous track due to itscaustic action.
The tract length of fistula was 2cm. Ksharasutra was changed for twotimes (fig. 2, fig. 3) and laying open ofresidual tract was done on4th week (fig. 4). The ulcer was healed up by next three weeks.
This patient has no complaint of faecal incontinence and there is no recurrence after one year follow up.
11 Jul, 2017
30 Jun, 2017
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