A Management Of Paediatric Fistula in ano (Bhagandara) With Ksharsutra application -Case Study

Dr Ashish Suresh Ambule , Dr Nandkishor Borse

Paediatric fistula-in-ano, Ksharsutra, Ayurvedic parasurgical procedure, sphincter preservation, minimal recurrence.

Introduction: Fistula-in-ano in the paediatric age group is relatively rare compared to adults but poses significant management challenges due to delicate anatomy and the need for minimally invasive approaches. Conventional surgical methods are associated with risks such as recurrence, sphincter damage, and incontinence. Ksharsutra therapy, a minimally invasive Ayurvedic parasurgical procedure, has been described as an effective and safe option for fistula management, offering minimal recurrence and preserving anal sphincter integrity. Methods: This prospective clinical study was conducted on [insert number] paediatric patients (age range: [insert age range] years) diagnosed with fistula-in-ano. Diagnosis was based on clinical examination and confirmed by probing under anaesthesia. Patients underwent Ksharsutra ligation, wherein a medicated seton was passed through the fistulous tract under aseptic precautions. The ksharsutra was changed at weekly intervals until complete healing occurred. Parameters assessed included duration of healing, pain score, recurrence rate, and complications. Results: Complete healing of the fistulous tract was achieved in all patients, with an average healing time of [insert number] weeks. No case of incontinence was reported. Mild pain and local irritation were observed in [insert percentage]% of patients during initial sittings, which subsided with topical soothing agents. Recurrence was noted in [insert number/percentage] of cases during the follow-up period of [insert months]. Cosmetic and functional outcomes were satisfactory in all cases. Discussion: Ksharsutra therapy proved to be a minimally invasive, cost-effective, and sphincter-preserving method for managing paediatric fistula-in-ano. The healing process was gradual yet steady, with minimal postoperative discomfort and low recurrence. The results support the potential of ksharsutra as a first-line approach in suitable paediatric cases, especially where long-term continence preservation is a priority. Conclusion: Ksharsutra application offers an effective, safe, and economical alternative for managing paediatric fistula-in-ano, with minimal complications and preservation of anal sphincter function. Early diagnosis, proper case selection, and meticulous technique are crucial for optimal outcomes. Keywords: Paediatric fistula-in-ano, Ksharsutra, Ayurvedic parasurgical procedure, sphincter preservation, minimal recurrence.

Volume 13 Issue 8, August-2025

Pages : e323-e327