Treatment of Fistula in ano by Kshara Sutra

Choi, Kyung Dal

Abstract

PURPOSE
Sushrutra (BC 5th century) advocated a conservative management by applying Kshara Sutra (phyto-chemically processed thread) for the treatment of anal fistulas in India. In 1965, this technique was introduced by Deshpande and 40 cases were treated on an "outpatient" ambulatory basis. The purpose of this study is to determine the result of Kshara Sutra (KS) in treatment of fistula in ano.
METHODS
One hundred and five patients with anal fistula were treated with KS. Excision of the primary lesion and fistula tract was done externally and KS was passed around the tract. Tissue gripped within the thread was the anoderm, mucosa, and sphincter. Finally, the thread encircled the part of the anal wall that needed excision and an additional clamp for loose tying.
RESULTS
The range of age was from 21 to 59 years while the sex ratio was 6.5:1 (M:F). In 94 patients, the average cutting time was about two weeks, and the other were three to four weeks. KS thread was applied only once for primary operation in 98 cases, and a successive change was required in 7 cases. The mean hospital stay after operation was 4.2 days. In 76 cases, the mean period of follow up was 23 (range 7~32) months. There were no recurrences, but there were 4 mild deformities of the anus, 2 mild soilings, 1 delayed cutting, and 5 delayed healings.
CONCLUSIONS
Kshara Sutra is a technically easy, safe, and simple method and does not require a long hospitalization.