I am Dr. SK Singh. I did my post graduation in ayurvedic surgery that is MS Ayurveda from institute of medical sciences Banaras University, BHU .So today I am going to talk about anal fistula. Anal fistula is a very now it is very commonly seen in the general public and it presents itself as a small swelling in the anal region, there is a swelling with some pain and sometimes the discharges like pus or watery discharges may also be noticed. So basically any type of any swelling with or without pain which is located near the anal region and sometimes the pus or watery discharges are noticed from the swelling, this is a very common indication for anal fistula. This indicates that the problem maybe anal fistula.
Now we talk about the treatment. This is a common feature of anal fistula, now we talk about the treatment. The treatments which are available nowadays there are large number of options are available because in modern surgery if you talk about modern surgery initially it was fistulectomy which was done and after that they since fistulectomy has its own complications like anal incontinence, recurrence of the disease, most of complications like pain, bleeding etc. So other options were thought about and amongst those options which were tried in the past they are like glue technique was there, the laser was tried and now a days it is the VAFT that is video assisted anal fistula treatment which is also known as MAFT as minimal anal fistula treatment they are being tried but unfortunately in all these options with all these options the treatment of fistula has not been has not been very confirmed that there is no as because even in these conditions also recurrences are being noticed. Now if we if we look back towards the surg in the of the in in the past years, now if we thought about the in the past years in the past 1500 years B.C if we talk about this disease was there and this was mentioned this has been mentioned in ayurvedic text as Bhagandara. Now this treat this anal fistula was treated in those days with the with Kshar Karma and Kshar Sutra chikitsa.
Now this kshar sutra chikitsa is a non surgical treatment. This kshar sutra treatment is a non-surgical is a para-surgical treatment usually it does not require any major surgical incisions or surgical or damage to the tissues. Precisely what is it in this technique we have to first define the track of the fistula and that could be done by MRI fistulogram or we can with delicate gentle probing also we can find out the depth, direction and the branching pattern of the fistulous tract. Now once this depth, direction and branching pattern of the fistula has been defined, then a medicated thread that is known as kshar sutra that is under certain under local anaesthesia with certain equipments, this thread is being replaced in the fistulous tract.
The medicine which is released from this thread from this kshar sutra usually deprives the fistulous tract gradually. It cleans off it clears off all the unhealthy fibrous tissue collections etc which are present in the fistulous tract and which are preventing the healing of the fistula. Since this this basically this if you thought if you if you if we try to explain the mechanism of action, see basically thread is a media by which we are delivering the medicines that it kshara precisely in the tract which are existing in the fistula. So with the help of thread, the medicine is being is reaching to the into the entire tract and the medicine is cleaning the tract and body its itself spontaneously healing is there.
Now the healing rate with this kshar sutra is approximately 0.5-1 cm per sitting i.e to say that once the thread has been placed, the medicine is being released, it is working and debriding the tract but this medicine remains active for 5 to 7 days and after that the medicine is finished so this thread has to be replaced by a new thread at weekly or 10 days interval. Now this system of change that is what we call as secondary sittings, this continues till there is a final cut through that is to say that the fistula is the thread is gradually coming down at the rate of 0.5-1 cm per sitting and the length of the thread, the loop length of the thread is also reducing and gradually the thread is coming towards the periphery and then it is it comes out with the simultaneous simultaneous healing which is following the thread. So this is the best way to treat the anal fistula which does not require any hospitalization or bed rest, you can continue your normal routine activities as usual.
Now so far as the clinical trial is concerned the thing is that whether this treatment is effective or not, let me tell you this the clinical trial, the comparison between surgery and kshar sutra, this was conducted long back by ICMR Indian council of medical research and the the clinical trials were conducted at 4 premium medical institutes including AIIMS Delhi, PGI Chandigarh etc and the ICMR researchers they are concluded that the kshar sutra treatment is more effective and more convenient as compared to surgery in the patients of anal fistula. So this is an unbiased that if the unbia this is being concluded that in whatever type of treatments present nowadays to treat anal fistula, the best worked therapy is the kshar sutra therapy. As speci this is a specialised therapy of ayurvedic shalaya chikitsa, ayurvedic shalaya chikitsa paddhati. This so this is being done and I would like because the masses are not aware about this kshar sutra. They do confused it with Bengali treatment or unethical treatment which is being which is being commonly seen in the nearby areas also.
So this is this this kshar sutra is a scientific techno scientific treatment which has been evaluated scientifically and is a part of ayurvedic system of medicines and surgery. This has nothing to do with the Bengali treatment. Basically what is more to my information Bengali treatment there is some some people are doing it that they are putting they are not calling this the Bengali treatment has not been scientifically evaluated. They used to put the thread and they are simply cutting the tissues with the thread. Every day they are cutting it and then they are putting a pressure this is basically a mechanical work cutting of the tissue which is which is unethical. It should not be done. The best option is of kshar sutra chikitsa.
So just for your information I would have delivered this I would have passed this information to you and you should like and I would request you to spread this information about in in the masses so the people who are suffering from anal fistula should get a proper information and and they should get this information that there is an option that is which is from ayurvedic surgery and which is far better than modern surgery or any X system existing in in in the medical science for for the management of anal fistula.
Thank you very much.