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सोमवार, 16 मई 2011

Anal Fistulae

Anal Fistulae

KSARA SUTRA IN MANAGEMENT OF ANAL FISTULA (BHAGANDRA)

Anal fistula is a track, which opens deeply in the anal canal or rectum and superficially on the skin around the anus. Sometimes, the track may have a single opening which is called a sinus. Generally, this track develops from ano- rectal abcess (Bhaganrda pidika), which bursts spontaneously or is incised inadequately. An anal fistula may occur with or without symptoms. There may be intermittent swelling with pain, discomfort and discharge of pus in the perineal region. This track does not heal due to fecal contamination, presence of unhealthy granulation tissue, and lack of rest to the part. This is a purely surgical condition but surgery is associated with a lot of complications and recurrence rate is also quite high after surgery.

Ksara sutra technique: The patient is made to lie down in lithotomy position taking all aseptic precautions. The Ksara sutra, with the help of probe specially designed for Ksara sutra is introduced from external orifice of fistula to the internal orifice inside the ano- rectal canal and is brought out through anus. The two ends of the thread are tied to form a loop. The wound is dressed with medicated oil/ghee. The Ksara sutra sutra is changed every week till the whole track is cut through and healed. Under post operative procedure patient is advised to use warm water sitz bath, application of medicated oil, laxative regularly during the treatment. Analgesics and anti-inflammatory drugs can also be used, if needed.

Clinical trial

About 700 patients, including 200 patients of recurrent fistulae after operation have been studied by Clinical Research Enquiry at IMS, BHU, Varanasi with Ksara sutra therapy. Out of 700 patients 691 (98.7%) have been completely cured.

Further studies on 395 patients have been conducted in the Council’s Research Institutes and the outcome has been similar, since 386 (97.72%) patients responded.

This technique has been very well accepted/adopted by the practitioners of Ayurveda. The efficacy of this approach has also been proved by studies conducted by Indian Council of Medical Research (ICMR). The facilities for the application and research on the techniques of Ksara sutra are further developed at Central Research Institutes of Ayurveda under the Council at New Delhi, Mumbai and Patiala. The Institutes have also arranged training programmes and workshops on the Ksara sutra technique. Further steps are proposed for its extension to other Institutes of the Council.

The patients undergoing Ksara sutra treatment are advised certain Do’s and Don’ts to facilitate early healing.

Do’s: Diet and habits
a) Strictly follow instructions given by the doctor.
b) Keep ano- rectal part clean and dry.
c) Consume lot of liquids.
d) Butter milk is very useful in these conditions.
Eat fruits and plenty of vegetable especially cucumber, radish, cabbage, carrot, green leafy vegetables, etc.

Don’ts
a) Avoid constipation and straining in the toilet.
b) Avoid chilly, spicy, non-vegetarian and other heavy food items.
c) Avoid sitting, standing and walking for long duration
The Ksara -Sutra being an OPD procedure does not require anaesthesia, heavy medication and hospitalization. After application of Kshara-sutra, patients can perform their routine duties. There are no side effects/complications like in continuance of stool, delayed healing leading to infections. Besides being economical the tissue damage and pain is relatively less in this therapy.



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