Management of Vaginal Fistula by Kshar Sutra, a Minimally Invasive Treatment
Condition: Vaginal Fistula
MeSH terms: Vaginal Fistula; Fistula
Study type: Interventional

Summary: 
      Background:Fistula-in-ano is described as Bhagandara in the classics of Ayurveda, is an
      ancient surgical problem. It was commonly described even in the Vedic period. The description
      of Bhagandara, with the full text of its managements, can be gathered from the Sushruta
      Samhita, which is supposed to have been written in the second century B.C. Fistula-in-ano is
      a tubular ulcer formed around the peri-anal region. It may also be found anywhere in the
      perineal region. Its ramifications can extend to the lower back, subscrotal region, vagina
      etc.

      Hypothesis:In Sushruta Samhita(2nd BC) Acharya Sushruta has advocated Kshar Sutra treatment
      due to probability of recurrence after surgery. The present treatment modality Kshar Sutra
      has been found effective and as adjuvant therapy by avoiding recurrence.
    

Detailed description: 
      A 42 years old female patient , come to the Shalyatantra O.P.D. of Government Ayurved
      Hospital,Nagpur with complaints of recurrent discharging boil at right side of Perianal
      region along with pain and discomfort in October 2010.

      She gave a surgical history of incision and drainage for gluteal abscess done in year 2008
      and after six month. The same complaint recurred after next six month .On local examination
      Patient had discharging sinus at 9 o clock position on right side of Perianal region. Before
      planning the treatment other etiologies like tuberculosis, diabetes mellitus , HIV or trauma
      were ruled out.

      For the conformation of diagnosis Fistulogram was performed suggestive of low anal fistula
      with posterior internal opening. So under spinal anaesthesia probing was done. But it came to
      know that the track was directed upward in vagina and it had not any other opening in anal
      canal. Length of the tract was 7cm.

      After conformation of vaginal fistula the track was cleaned with betadine and Hydrogen
      peroxide. The Kshar Sutra was tied covering the entire underlying track for simultaneous
      cutting and healing under all aseptic precaution. The patient was discharged on the next day
      of procedure. Patient was advice for Seitz bath with lukewarm water. The Kshar Sutra was
      changed weekly. To promote healing and to reduce pain and inflammation oral antibiotics,
      anti-inflammatory medicine were also prescribed.

      The total period of Kshar Sutra treatment was two month. The track cut trough and
      simultaneously healed. It was observed that healing rate was slow as compare to cutting rate.
      In this patient. The patient was observed for a period of two year to check for recurrence.

      The Kshar Sutra is a standard medicated thread smeared with Kshar of Apamarga (Achyranthus
      Aspera), Shnuhi (Euphorbia Nerrifolia)latex which has quality of cutting and Haridra (Curcuma
      Longa) which is used as a antiseptic. This combination of drugs on the thread helps in
      debridement and simultaneously healing.
    

Intervention name(s): Kshar Sutra
Intervention type(s): Other
Intervention description(s): The Kshar Sutra is a standard medicated thread smeared with Kshar of Apamarga (Achyranthus Aspera), Shnuhi (Euforbia Nerrifolia) which has quality of cutting and Haridra (Curcuma longa) which is used as a antiseptic. This combination of medicine on the thread helps in debridement and simultaneously healing of track. After conformation of vaginal fistula the track was cleaned with betadine and Hydrogen peroxide. The Kshar Sutra was tied covering the entire underlying track for simultaneous cutting and healing under all aseptic precaution. The patient was discharged on the next day of procedure. Patient was advice for Sitz bath with lukewarm water. The Kshar Sutra was changed weekly.
Other intervention name(s): Medicated thread
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Fistula , Bhagandar