Efficacy of Kshar Sutra (medicated seton) therapy in the management of Fistula-in-Ano
Background Fistulas in ano are common at any time of human life and difficult to manage. Aims To compare Kshar sutra (medicated seton) therapy with linen thread in the management of fistula in ano. Histopathologic study was undertaken to compare the pattern of excision of fistula. Settings and Design A nonblinded, noncrossover prospective randomised controlled study. Methods and Materials The technique involved passing a medicated seton through the fistulous tract. The concept of Kshar Sutra Therapy has been taken from ancient Ayurvedic classic "Sushruta Samhita". Sixty patients with fistula in ano of cryptoglandular origin were selected and divided into two groups of thirty patients each. Group A was treated with Kshar sutra and the Group B with the surgical linen thread number 20. Statistical analysis used Student’s t-test (SPSS Version 7.5.1) was applied for statistical analysis. Results The healing occurred in all the patients treated either with Kshar Sutra or plain thread. The median healing time was 7 weeks for Kshar Sutra and 11 weeks with plain thread. Recurrence rate was only 3.33 percent (1 patient) with the Kshar Sutra and 13.33 percent (4 patients) with plain thread. Mild incontinence led to complete recovery during follow-up irrespective of whether treated with the plain thread or Kshar Sutra. Histopathologic study showed that the cutting and healing of the fistulous tract was not a mechanical effect of Kshar Sutra only but it was also due to anti-inflammatory and the chemical properties of the drugs. Conclusion The technique of Kshar Sutra therapy is appropriate for healing of the fistulous tract with minimal complications and insignificant rate of recurrence and incontinence.
Pankaj Srivastava Dr. and Manoranjan Sahu Prof.
"Efficacy of Kshar Sutra (medicated seton) therapy in the management of Fistula-in-Ano,"
World Journal of Colorectal Surgery:
1, Article 6.
Available at: http://services.bepress.com/wjcs/vol2/iss1/art6
Passage of probe threaded with Kshar Sutra into the external opening of the fistula
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Kshar Sutra taken out from the internal opening of the fistula
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Kshar Sutra is being snugly taut out side the anal opening
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Microphotographs showing predominance of chronic inflammatory cells and vascular proliferation with healthy granulation in patient treated with plain thread (H&E, 250X)
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Microphotographs showing healthy granulation with decreased inflammatory cells in patient treated with Kshar Sutra (H&E, 250X)