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Fistulas: what is the ultimate solution? Is Kshar Sutra the answer?

The treatment of some diseases can be a real challenge not only for the patient but also for the doctor. Anal fistulas occur when a channel is formed between the end of the bowel (rectum or anal canal) and the surrounding skin. Many patients are affected with a simple fistula, but the condition is often complicated by multiple interconnected channels and distant openings. The most troublesome of these fistulas are recto-inguinal, recto-vaginal, and ano-scrotal.

Many treatment options are available, so there is always a debate about which one is better than the other. The Kshar Sutra is an ancient Ayurveda technique that originated in India . Archaic Indian literature mentions the Kshar Sutra. A method of treating Bhagandara ( Sanskrit for fistula ) was supposed to be the work of Sushruta ( ancient Indian surgeon). Modifications have been made to the technique in light of modern times. By using cotton thread impregnated with layers of medicinal plant extracts (latex), Seton is used to make this mask. The Kshar Sutra takes about four weeks to prepare. As well as treating fistulas, it is also used to treat hemorrhoids, sentinel piles, polyps, warts, and pilonidal sinus.

What is the ancient technique of fistula-in-ano?

After giving appropriate anesthesia, the Kshar Sutra is placed in the fistulous tract and tied at both ends. It is replaced every week. By remaining in direct contact with the tract, the Kshar sutra physically and chemically cleans out the tract and sloughs off its lining, thereby allowing it to collapse and heal. It is a less invasive, more cost-effective treatment. Anal incontinence is unlikely to result from loss of sphincter control; complications are minimal.

A disadvantage of Kshar Sutra is that it is a multi-staged procedure that requires weekly hospital visits. As a result, wound infection tends to be more common with this technique than with others. Additionally, healing takes longer with this technique. It's subjective how painful Kshar Sutra is compared to other procedures, and it may be less painful or more painful than other procedures. While a simple fistula can be treated with this technique, its efficacy in complicated ones remains controversial.