Comparing Ksharasutra (Ayurvedic Seton) and open fistulotomy in the management of fistula-in-ano

Abstract

Background:Most commonly practiced surgical “lay open” technique to treat fistula-in-ano (a common anorectal pathology) has high rate of recurrence and anal incontinence. Alternatively, a nonsurgical cost efficient treatment with Ksharasutra (cotton Seton coated with Ayurvedic medicines) has minimal complications. In our study, we have tried to compare these two techniques.Materials and Methods:A prospective randomized control study was designed involving patients referred to the Department of General Surgery in RG Kar Medical College, Kolkata, India, from January 2010 to September 2011.Results:Among 50 patients, 26 were in Ksharasutra and 24 were in fistulotomy group. 86% patients were male and 54% of the patients were in the fourth decade. About 74% fistulas are inter-sphincteric and 26% were of trans-sphincteric variety. Severe postoperative pain was more (7.7% vs. 25%) in fistulotomy group, while wound discharge was more associated with Ksharasutra group (15.3% vs. 8.3%). Wound scarring, bleeding, and infection rate were similar in both groups. Ksharasutra group took more time to heal (mean: 53 vs. 35.7 days, P = 0.002) despite reduced disruption to their routine work (2.7 vs. 15.5 days work off, P <0.001). Interestingly, pain experienced was less in Ksharasutra group, there was no open wound in contrast to fistulotomy and it was significantly cost effective (Rupees 166 vs. 464).Conclusion:Treatment of fistula-in-ano with Ksharasutra is a simple with low complications and minimal cost.

Comparison of “medicated seton versus fistulectomy” in the management of fistula-in-ano in tertiary care hospital

“…Reddy VM et al and Gouranga D et al has similar results as compared to our studies. 2,5 In present study the duration of treatment in the seton group was significantly longer than fistulectomy group. The mean duration of healing was 67.35 days in medicated seton group.…”

“…Gouranga D et al; Gupta Shyam K et al and Shukla N et al had similar results. 2,4,6 In present study, no patient from seton treatment group developed incontinence for liquid/flatus/faeces. While 2 (10%) patients from fistulectomy group developed incontinence, one for flatus/liquids and one for faeces.…”

Initial results of using VAAFT in the management of fistula-in-ano: a prospective observational study

“…3 Use of Ksharasutra (Ayurvedic medicated cotton thread) or cutting Setons have known to preserve sphincter functions but still they cause various complication like incontinence, chronic discharge and prolonged healing time. [6][7][8]10 Fibrin glue injections have easy technique with minimal side effects, but long-term success rate is 14%. 4 Trans anal Advancement Flap Repair (TAFR) is a sphincter saving technique with recurrence rates from 7-49%.…”

Challenges in integrating component level technology and system level information from Ayurveda: Insights from NMR phytometabolomics and anti-HIV potential of select Ayurvedic medicinal plants

“…Despite Western medicine being the frontline medical system in India, Ayurveda continues to address many health issues [1], [2], [3], [4], [5] thereby contributing to the healthcare, independent of the Allopathic system of medicine [6]. At the same time, Ayurveda has also allowed its vast documented knowledge of clinical practices, formulations and medicinal plants to be used by Western medicine [7], [8], [9], [10], [11], [12], [13]. For instance, drug molecules such as curcumin [14], guggulsterone [15], [16] and reserpine [17] have been identified with lead information from Ayurvedic pharmacopoeia.…”

“…For instance, drug molecules such as curcumin [14], guggulsterone [15], [16] and reserpine [17] have been identified with lead information from Ayurvedic pharmacopoeia. Increasing interest in Western medicine in the use of kshārasutra in fistula-in-ano [9], and leech to relieve pain [7] and venous congestion [8] are other examples. Ayurveda thus remains extremely resourceful and of interest to the Allopathic system of medicine.…”