Abstract

MANAGEMENT OF RECURRENT FISTULA IN ANO BY IFTAK TECHNIQUE

*Prerna Verma, Prof. S.J. Gupta

Abstract

Fistula in ano is the most challenging surgical disease to manage,with complex fistulas presenting even greater difficulties due to its intricate anatomy and high recurrence rates. The primary concern in treating fistula in ano is a risk of damage to anal sphincters which can compromise faecal continence and its high recurrence rate. Case Presentation: Here, we present a case of complex fistula in ano, treated successfully by the IFTAK technique (Interception of fistulous tract with the application of Ksharsutra) practiced at Banaras Hindu University, Varanasi, India. In the present case study, a 40 years old male patient came to our OPD of Shalya Tantra, Ayurveda Hospital, with a chief complaint of pain and pus discharge from perianal region since last 4 years. Internal opening also present at 6 o’ clock position into the anal canal at dentate line on digital per rectal examination. Probing was also done to confirm the site of internal opening of bhagandara. Patient was already operated twice for fistula outside B.H.U. Patient did not have previous H/O any medical and surgical illness with negative family history. Patient was diagnosed a case of Recurrent Fistula-in-ano on the basis of clinical presentation. Fistula was completely healed in due course of time without impairing anal continence status of the patient. At 6 months of follow up, the patient was healthy and no recurrence was found. Conclusion: IFTAK is a minimally invasive technique and is very effective in managing complex fistula in ano of cryptoglandular origin. The main cause of recurrence in complex anal fistula is non-identification of an infected anal crypt, secondary extensions, associated sepsis or abscess at the time of surgery. So, precise diagnosis and appropriate surgical measures play an important role in the successful treatment of anal fistula, failure to either will result in non-healing or recurrence.

Keywords: fistula in ano, IFTAK, Ayurveda, Ksharasutra.