Case Study Multiple Stage Surgical Approach along with Ksharasutra Therapy in the Management of High Anal Fistula (Bhagandara)

Abstract

Background: Anal stulas are relatively common in today's clinical practise, and despite improvements in surgical procedures, treating them is a time-consuming task. Bhagandara, a disease mentioned in Ayurveda that is supposed to be very difficult to treat, is similar to anal stula.
As a result of the difficulty of using merely Ksharasutra (alkaline seton) to treat high anal stulas, which have an internal opening that is above the dentate line and an exterior opening that is a significant distance from the anal edge, numerous surgical approaches have been used in this circumstance.
Materials & Methods: stulotomy and Ksharasutra were used in three phases to treat the patient. To establish hemostasis, the external incision was first expanded toward the anal canal by around 5 cm. Curettage and packing were also performed at this step. During the second step, the tract extended 2 cm toward the anal canal and was stuffed, which took place after a month. Ksharasutra was used in the third stage for eight weeks till the tract was severed and healed fully.
Results: It was approximately a year before all of the stulous tract had healed, although the hospital stay was just a few days. After six months of monitoring, there was no sign of the problem recurring. The outcomes of this trial were positive, and the patient was able to return to his normal schedule with little hospitalisation.