Management of Low Anal Fistula by Chedana and Ksharkarma A Case Study and Review of Literature

Abstract

Introduction:-Bhagandara is considered under the Ashta Mahaarogas (Eight grave disorders).The prevalence rate of fistula-in-ano has been accepted as second highest after piles in ano-rectal disorders. Sushruta has given equal emphasis to surgical as well as parasurgical measures for the management of bhagandara, he advocated chedana (fistulectomy) of fistulous tract followed by ksharkarma. Aim: To evaluate the efficacy of chedana (fistulectomy) with ksharakarma in management of low anal fistula. Material & Methods: A 43 years old male patient visited OPD with throbbing pain in ano, swelling and fever with chills. On examination external opening was seen at 11 o’clock approximately 4 cm from anal verge with abscess. TRUS (Transrectal Ultrasonography) was done to confirm the diagnosis. Patient had history of surgery before 2 years for drainage of perianal abscess. So, it was diagnosed as a case of perianal abscess with intersphicteric low anal fistula. Chedana (fistulectomy) followed by teekshna Apamarga kshara application under spinal anesthesia (Xylocaine 2% with adrenaline) was done. Observation And Results: The wound was assessed weekly and it was observed that in first week pain was reduced completely. On second week healthy granulation was observed without any discharge. The wound healed completely within one and half month with minimal scar formation and normal skin coloration. Conclusion: This single case study concluded that chedana (fistulectomy) with ksharkarma is one of the option for management of low anal fistula.