Two-staged surgical approach along with Ksharasutra therapy in the management of complex, non-specific, posterior, horse-shoe-shaped fistula-in-ano: A case report

Abstract

Bhagandara is one of the Ashtamahagada (~eight grave diseases) that resembles with the anal fistula in modern parlance. Many surgical techniques are available in modern practice though management of the fistula is challenging due to its high recurrence rate and associated complications. This study aims to diagnose a case of fistula-in-ano and to treat the case by two-staged surgical approach along with Ksharasutra. A 28-year-old male patient came to out patient department (OPD) of Shalya tantra with complaints of painful swelling with pus discharge from perianal region, which was diagnosed as complex, nonspecific, posterior horse-shoe shaped fistula-in-ano with approximately 80 mm long track. The condition is not only difficult but also takes a longer period for complete cure with varied success rate, hence, two-staged surgical approach along with Ksharasutra has been employed. The fistulous track was completely healed by almost 13 weeks. Follow-up was done for the next three months. There was no recurrence of the condition, and normal sphincter tone was achieved. The result of the present case is encouraging, and the patient was treated effectively without any complications and without disturbing his daily social life.