ROLE OF ASPHOTA (HEMIDESMUS INDICUS R.BR.) KSHARASUTRA IN THE MANAGEMENT OF LOW-ANAL FISTULA

In this modern era, due to a sedentary lifestyle and improper dietary habit digestive disorder shows greater inci- dence. Among them, fistula-in-ano is troubleshooting one, which is a communicating tract between two epithelial surfaces lined by granulation tissues. Due to the higher recurrence rate and postoperative complication fistula-in- ano is a headache in the present era. In Ayurvedic classics, Ksharasutra prayoga is mentioned for the treatment of Nadi Vrana, which can be adopted in the management of anal fistula. The objective of the present study was to be evaluated the efficacy of Asphota Kshara sutra in the management of low anal fistula. The clinical trial was con- ducted in OPD and IPD of Shalyatantra department at Pankajakasthuri Ayurveda Medical College. The intervention was ligation of the fistulous tract with Asphota Ksharasutra. 25 subjects were selected satisfying inclusion and exclusion criteria. The clinical assessment was done before treatment, after treatment and follow up on the 30th day after cutting through of the tract. The assessment was done based on parameters prepared for anal fistula by Paul O Madson and Peter. Pain, burning sensation, inflammation, itching, discharge and unit cutting time was statistically analysed in different periods. Outcome variables were analysed statistically by using the Friedman test and Wilcox- son signed-rank rest, and a conclusion was drawn. Pain, burning sensation, inflammation, discharge, itching was effectively managed using Asphota Ksharasutra. The unit cutting time of Aspota ksharasutra was found to be more than standard Ksharasutra. The result showed that Aspota Ksharasutra is effective in the management of low anal fistula. Keywords: Fistula-in-ano; Asphota ksharasutra.

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A comparative study in the management of fistula in ANO using various modalities

International Surgery Journal ◽

10.18203/2349-2902.isj20182226 ◽

2018 ◽

Vol 5 (6) ◽

pp. 2223 ◽

Cited By ~ 2

Author(s):

Ramachandra M. L. ◽

Mayank Garg

Keyword(s):

Fistulous Tract ◽

Selection Method ◽

Fistula Tract ◽

Internal Opening ◽

Necrotic Tissue ◽

Fistula In Ano ◽

Sphincter Function ◽

Medical College ◽

Operative Complications ◽

Comparative Prospective Study

Background: Fistula in ano is a track that connects deeply the anal canal or rectum to the skin around the anus. Fistula in ano most commonly follows an anorectal sepsis1. The main principles of management of anal fistula are closure of internal opening of fistula tract, drainage of infection or necrotic tissue, and eradication of fistulous tract with preservation of sphincter function. The objectives were to compare the various aspects like per operative complications, post-operative complications, mean hospital stay in the treatment of fistula in ano using various modalities like fistulotomy, fistulectomy, setons and lift procedure.Methods: This is a randomised, comparative, prospective study of 80 cases of fistula in ano, presenting at surgical opd of K.R. Hospital, Mysore attached to Mysore Medical College and research Institute. Out of which, 20 cases are treated by fistulectomy, 20 by seton, 20 by fistulotomy and the rest 20 cases by LIFT procedure by random selection method, during period of NOVEMBER 1, 2016 to 31st October 2017.Results: Most common age of presentation is 31-40 years and more common in males then females (M:F= 2.3:1 ). Per operative complications include bleeding seen more in patients undergoing fistulectomy. Per operative course of LIFT procedure patients was complication free. Postoperative pain seen more in patients undergoing setons procedure.Conclusions: we conclude that LIFT procedure and Fistulotomy were acceptable procedures for simple, uncomplicated low lying and high lying fistula.

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Comparative study of MRI fistulogram and X-ray fistulography with operative findings: in fistula in ano

International Surgery Journal ◽

10.18203/2349-2902.isj20191894 ◽

2019 ◽

Vol 6 (5) ◽

pp. 1704 ◽

Cited By ~ 1

Author(s):

Nishant Tripathi ◽

Shahaji Chavan ◽

Mahendra Bendre ◽

Vishal Sharma

Keyword(s):

Prospective Study ◽

Fistulous Tract ◽

Research Centre ◽

College Hospital ◽

Fistula In Ano ◽

X Ray ◽

Medical College ◽

Group A ◽

Group B ◽

Operative Findings

Background: The current study has attempted to evaluate the effectiveness and diagnostic accuracy of MRI fistulogram over X-ray fistulography by comparing their findings with intraoperative findings.Methods: A hospital based prospective study was conducted at Dr. D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune with 60 patients to compare the findings of MRI fistulogram and X-ray fistulography with operative finding in fistula in ano. The study was carried out with following two groups of 30 patients each. Group A -30 cases underwent MRI fistulogram. Group B: 30 cases had done X-ray fistulography. Its findings were compared with the final findings of the operation.Results: On evaluation of the intra-operative findings with MRI fistulogram, we found that inter-sphincteric fistulous tract were noted in 23 patients as compared to 22 patients detected by MRI. In the rest of the findings the sensitivity of MRI with intraoperative findings was nearly 100% with a significant correlation. Sensitivity and specificity of X-ray fistulogram for fistula in ano was very low.Conclusions: The results have been statistically significant in providing data in favour of MRI fistulogram as diagnostically superior to X-ray fistulography.

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Evaluation of the role of cyanoacrylate glue in the management of fistula-in-ano

International Surgery Journal ◽

10.18203/2349-2902.isj20200811 ◽

2020 ◽

Vol 7 (3) ◽

pp. 721

Author(s):

Davinder Koli ◽

Pravin Kumar ◽

Viraj Panda ◽

Manu Vats

Keyword(s):

Anal Fistula ◽

Fistulous Tract ◽

Significant Risk ◽

Digital Rectal Examination ◽

Fistula Tract ◽

Internal Opening ◽

Cyanoacrylate Glue ◽

Fistula In Ano ◽

Infant Feeding Tube

Background: Fistula in ano is a common problem in patients presenting to surgical OPD. Various procedures have been described for the treatment of anal fistula, including fistulectomy, fistulotomy and use of a cutting seton. Surgical treatment of anal fistula is associated with a significant risk of recurrence and faecal incontinence due to damage to anal sphincter. The introduction of cyanoacrylate glue to close fistula tracts using an occlusive material and with no risk of incontinence (as there is no sphincter damage). The study was designed to evaluate the role of cyanoacrylate glue in the management of fistula in ano.Methods: Here, 40 patients were enrolled in study as day cases. Patients were examined clinically and subjected to MRI pelvis where internal opening couldn’t be palpated on digital rectal examination (DRE). Fistula tract was mapped using fistula probe and washed with diluted hydrogen peroxide and normal saline. The excess granulation tissue at the external opening was curetted. The glue was then injected slowly into fistulous tract through 8 F infant feeding tube. Patients were further examined in the OPD until 6-months.Results: Here, 32 patients got healed after first instillation of glue with stoppage of discharge from the fistulous tract. The other 2 patients required second instillation of glue and showed no signs of discharge thereafter. While 6/40 continued to discharge even after instillation of glue.Conclusions: Cyanoacrylate glue can be offered as a sphincter sparing alternative to conventional procedure in patients with anal fistula.

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Outcome of Seton in the Management of Complex Fistula in Ano in a Tertiary Care Center in Bangladesh

Journal of Shaheed Suhrawardy Medical College ◽

10.3329/jssmc.v12i1.51613 ◽

2021 ◽

Vol 12 (1) ◽

pp. 15-19

Author(s):

Md Armanul Islam ◽

Md Mahfuzur Rahman Khan ◽

Md Mustafizur Rahman ◽

SM Quamrul Akther ◽

Md Mozammel Hoque ◽

...

Keyword(s):

Anal Fistula ◽

Care Center ◽

Fistulous Tract ◽

Tertiary Care ◽

Fistula Tract ◽

Internal Opening ◽

Narcotic Analgesics ◽

Cross Sectional ◽

Fistula In Ano ◽

Complex Fistula

Background: The management of high and complex anal fistulas remain a therapeutic challenge as it is often associated with recurrence and anal incontinence. The oldest and theoretically the simplest technique is to use a seton. The aim of this study is to find out the outcome of seton in the treatment of complex fistula in ano. Materials and methods: This cross-sectional study was done in surgical units of ShSMCH and colorectal surgery units of BSMMU from September 2014 to August 2015. Fifty patients with high anal fistula having internal opening above dentate line and with multiple fistulas tract were included by purposive sampling. Patients with low anal fistula, fistula in ano associated with Crohn’s disease, active abdominal tuberculosis, carcinoma of rectum, previous radiation therapy, with recurrent fistula in ano and in whom the internal opening could not be located were excluded. After initial evaluation, the fistula tract and opening were located. The skin and anoderm overlying the fistulous tract were incised. This double-strand seton was then tied over itself on the sphincter without excessive tension. The long end of each suture was tapped to the patient’s medial thigh. Postoperatively warm sitz bath after each bowel movement was advised. The patients were informed in detail about the presence of seton prosthesis and they were warned about the possible serous discharge that would continue until the seton dropped, and the wound healed. Data were recorded on the predesigned questionnaire and analyzed using SPSS version 16. Results: Among 50 cases mean age was 41 years, M: F was 4.5:1. Discharge from perianal sinus, pain, swelling and itching were common clinical presentation. All of the patients were discharged on the third postoperative day. None required readmission or needed narcotic analgesics after discharge. The average time for the seton to cut through the sphincter was 1 to 3 months. 28% had complete healing at 1 month and 66% at 3 months postoperatively. Flatus Incontinence was noted 16% cases followed by recurrence (6%), liquid stool incontinence (4%) and postoperative anal stricture was (2%) of cases. Conclusion: This study found that the seton is a safe and low morbidity option for the treatment of high and complex fistula-in-ano, having higher healing rates, with good quality of life. It can therefore be recommended as the standard treatment for complex fistula-in-ano. J Shaheed Suhrawardy Med Coll, December 2020, Vol.12(1); 15-19

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The Use of Seton as a Bridge to Definitive Ligation of the Intersphincteric Fistula Tract Procedure for Fistula-in-ano: A Systematic Review and Meta-analysis

Journal of Coloproctology ◽

10.1055/s-0041-1730039 ◽

2021 ◽

Author(s):

Carlos Placer-Galán ◽

Jose Mª Enriquez-Navascués ◽

Tania Pastor-Bonel ◽

Ignacio Aguirre-Allende ◽

Yolanda Saralegui-Ansorena

Keyword(s):

Systematic Review ◽

Anal Fistula ◽

Meta Analysis ◽

Fistula Tract ◽

Cochrane Library ◽

Fistula In Ano ◽

Intersphincteric Fistula ◽

The Impact ◽

Seton Placement ◽

Primary Healing

Abstract Background There is still controversy over the usefulness of seton placement prior to the ligation of the intersphincteric fistula tract (LIFT) surgery in the management of anal fistula. Objective To evaluate the impact of preoperative seton placement on the outcomes of LIFT surgery for the management of fistula-in-ano. Design systematic review and meta-analysis. Data Sources A search was performed on the MEDLINE (PubMed), EMBASE, Scopus, Web of Science, Cochrane Library and Google Scholar databases. Study Selection Original studies without language restriction reporting the primary healing rates with and without seton placement as a bridge to definitive LIFT surgery were included. Intervention The intervention assessed was the LIFT with and without prior seton placement. Main Outcome Measures The main outcome was defined as the primary healing rate with and without the use of seton as a bridge to definitive LIFT surgery. Results Ten studies met the criteria for systematic review, all retrospective, with a pooled study population of 772 patients. There were no significant differences in the percentages of recurrence between patients with and without seton placement (odds ratio [OR] 1.02; 95% confidence interval [CI] 0.73–1.43: p = 0.35). The I2 value was 9%, which shows the homogeneity of the results among the analyzed studies. The 10 included studies demonstrated a weighted average overall recurrence of 38% (interquartile range [IQR] 27–42.7%), recurrence with the use of seton was 40% (IQR 26.6–51.2%), and without its use, the recurrence rate was 51.3% (IQR 31.3–51.3%) Limitations The levels of evidence found in the available literature were relatively fair, as indicated after qualitative evaluation using the Newcastle-Ottawa scale and the Attitude Heading Reference System (AHRS) evidence levels. Conclusions Our meta-analysis suggests that the placement of seton as a bridge treatment prior to LIFT surgery does not significantly improve long-term anal fistula healing outcomes. Ligation of the intersphincteric fistula tract surgery can be performed safely and effectively with no previous seton placement.International prospective register of systematic reviews—PROSPERO registration number: CDR42020149173.

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Effectiveness of the ligation of intersphincteric fistula tract (LIFT) in the treatment of anal fistula: initial results

ABCD Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) ◽

10.1590/s0102-67202014000200004 ◽

2014 ◽

Vol 27 (2) ◽

pp. 101-103 ◽

Cited By ~ 8

Author(s):

Sergio Danilo Tanahara TOMIYOSHI ◽

Carlos Henrique Marques DOS SANTOS

Keyword(s):

Fecal Incontinence ◽

Anal Fistula ◽

Anorectal Manometry ◽

Fistulous Tract ◽

Complete Healing ◽

Fistula Tract ◽

Anal Fistulas ◽

Intersphincteric Fistula ◽

The Mean ◽

Initial Results

BACKGROUND: The abscesses and anal fistulas represent about 70% of perianal suppuration, with an estimated incidence of 1/10000 inhabitants per year and representing 5% of queries in coloproctology. AIM: To evaluate the effectiveness of the interesphincteric ligation technique of the fistulous tract in the treatment of anal fistula. METHODS: The records of eight patients who underwent this technique, evaluating age, gender and presence of incontinence were studied. Was named technical first-step the passage of cotton thread to promote the correct individualization of the fistula and, as the second, the surgical procedure. RESULTS: Two patients were men and eight women. The mean age was 42.8 years. Of these, seven (87.5%) had complete healing of the fistula; six were cured only with this procedure and one required additional operation with simple fistulotomy. Only one patient developed fecal incontinence which was documented by anorectal manometry. There were no deaths in this series. CONCLUSION: The interesphincteric ligation technique of the fistulous tract proved to be effective for the treatment of anal fistula and should not be discouraged despite the occurrence of eventual fecal incontinence.

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Use of Seton in Management of High Variety of Anal Fistula

Anwer Khan Modern Medical College Journal ◽

10.3329/akmmcj.v8i2.33662 ◽

2017 ◽

Vol 8 (2) ◽

pp. 100-104

Author(s):

Mohammad Noor A Alam ◽

Sharmin Abbasi

Keyword(s):

Anal Fistula ◽

Low Cost ◽

Dentate Line ◽

Internal Opening ◽

Efficacy And Safety ◽

Medical College ◽

Small Channel ◽

A Prospective Study ◽

Low Rate

Background: Anal fistula is an abnormal communicative small channel that has an internal opening and an external opening and connected by the primary track. Our study evaluate the effectiveness of seton in high variety anal fistula.Objectives: Evaluation the efficacy and safety of seton as surgical management of high anal fistula. Methods: This is a prospective study done on 57 patients in BIRDEM hospital and some other clinic of Dhaka city in 3 years period with high variety of anal fistula which is above the dentate line and were treated with seton .Outcome measured during follow up period were- successfully healed, recurrence, incontinence, percentage of complications and patients satisfaction.Result: Among 57 patients mean age was 38.2+_6.8 years. Overall outcome of the patients showed-fistula completely healed in 51 patients, incontinence occurred in 2 patients and recurrence occurred in 4 patients.Conclusion: Seton is relatively safe, effective and low cost for the management of high anal fistula with low rate of incontinence. It can therefore, be recommended as the standard of treatment for high variety fistula in ano.Anwer Khan Modern Medical College Journal Vol. 8, No. 2: Jul 2017, P 100-104

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