Abstract

AN INNOVATIVE MANAGEMENT OF BHAGANDARA (W.S.R TO HIGH ANAL FISTULA): KSHARA SUTRA WITH PARTIAL FISTULECTOMY

Ranjan Kumar Kasta* and Bipin Bihari Khuntia

Abstract

Background: In Ayurveda, Bhagandara is considered one of the grave diseases by Sushruta due to its higher recurrence rate. Ksharasutra is a para-surgical procedure that is found more effective in the management of fistula-in-ano. Ksharasutra is routinely prepared with Snuhi Ksheera (latex), Haridra powder, and Apamarga Kshara. The treatment procedure of perianal fistula aims at complete eradication of sepsis while preserving continence. Identifying better treatment procedures would benefit the treatment of complex fistula in ano in terms of reduced recurrence and reduced postoperative morbidity in source-limited settings. Aim: To compare the efficacy of Apamarga Ksharasutra with partial fistulectomy and Apamarga Ksharasulta alone in the management of Bhagandara. Materials and Methods: In this research study, 60 patients of Bhagandara (fistula-in-ano) were selected and randomly divided into two groups. In group-A (n = 30), patients were treated only with application of Apamarga Ksharasutra and in group-B (n = 30), partial fistulectomy was done and then Apamarga Ksharasutra was applied in remaining fistulous tract. After the Ksharasutra application, patients were assessed for relief in symptoms such as pain, discharge, burning sensation, development of granulation tissue, and fistula tract length as parameters on a weekly follow-up basis, and Ksharasutra was changed by railroad technique up to complete cut through of the tract. Results: After 12 weeks of treatment maximum (53%) patients in group B were cured than group A (33%). Whereas 36.67% of patients in group A and 40% in group B were improved maximally after 12 weeks of treatment. This study revealed that Gr-B is more effective in reducing pus discharge, pain, burning sensation, granulation tissue development, and fistula tract length than Gr-A. Conclusion: Partial fistulectomy with Apamarga Ksharasutra is better than the Apamarga Ksharasutra application in Bhagandara (fistula-in-ano) cases.

Keywords: Bhagandara, Fistula-in-ano, Ksharasutra, Partial fistulectomy.