Sushruta Clinic- Multiple Fistulas


Any boil or abscess at perianal area which bursts with discharge or surgically drained is initially a Fistula. The
discharge of pus or blood may be intermittent or continuous soiling the under clothes.

Causes :-
1. Boil or abscess at perianal region which bursts with discharge.
2. Cryptoglandular anal infection leading to anal abscess formation which bust which discharge leading to
Anal Fistula.
3. Erosion and ulceration in anal canal provide the route for bacterial infection in anal canal. The infection
spreads to pararectal spaces leading to abscess formation and development of anal Fistula.
4. Anal Fissure is the most common cause of Anal abscess.
5. Blood born infection of pararectal spaces during malaria, Typhoid, Prolong illness, Tuberculosis, lower
resistance and diabetes may couse anal abscess formation.

Clinical feature :-
Initially an abscess or boil at perianal region either to burst with discharge or inadequatly drained leads
to fistula formation. Intermetent or persistant discharge of pus or blood with pain or without pain is the prominant
feature of Anal fistula.

Types of the Fistula :-
1. Law Anal
2. High Anal
3. Anorectal
4. High Intermuscular
5. Pelvirectal
Treatment of Fistula :-
Treatment of fistula is surgical.
The operative treatment of Anal fistula consists of fistulectomy or fistulostomy.

Fistulectomy :-
Complete tubular tract of Fistula is dissected from adjascent tissues and excised. Daily dressing is done.

Fistulastomy :-
A probe is passed into fistulous tract which is laid open completely and dressing is done.

Operative results of anal fistula :-
An average recurrence rate of Anal fistula after adequate surgery is about 50%. The results of high Anal and
horse shoe shape fistula are not satisfactory. Recurrence and incontinance for faeces and flatus are common
complications of surgery for Anal fistula. Really in anorectal and multiple horse shoe shape anal fistula excision
of the rectum and colostomy is the choice of operation for complete eradication of disease.
                                                 Kshar Sutra Treatment of Fistula in Ano :-

After complete clinical and pathalogical investigations the patient is placed on operation table in lithotomy position. A malleable silver probe threaded with Kshar Sutra in its eye is passed into fistulous tract and index finger of second hand is inserted into anal canal. With the tip of probe and index finger in anal canal internal opening of the fistula is negotiated and terminal and of the probe is brought out of anal orifice with the help of index finger. Thus the probe is removed leaving the Kshar Sutra into fistulous tract. With the two ends of thread, a strong knot is applied outside the Anus. Dry guage is placed at anal region and bandage is applied.

Post operative care :-

Hot sitz bath twice daily after defaecation, mild aperient at night, and jatyad tail enema before defaecation is recommended. The Kshar Sutra is changed at weekly interval till whole fistulous tract is cut through, leaving a small wound which heals up withing 10-20 days.

Results  :-

Post operative Kshar Sutra treatment of fistula in Ano was reviewed for 3-5 years. The clinical data of 1739 cases were analysed. The cure rate of Anal fistula was 98.4% with nominal recurrence of 1.6% only. Imparement of rectal continence was not seen in any patient as it is common complication of surgery specially in high anal fistula.

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Three times operated recurrent Fissure in ano with multiple external openings at 3, 5, 6, 8, 9'o clock. Single thread is applied at 6'o clock.
Progressive healing of branches tracts. Kshar Sutra is in situ.
Healing is progressive and opening at 8, 9 and 5'o clock healed up.
Kshar Sutra is situ all the opening healed up, regenerative changes in right gluteal cushion is remarkable.
Last stage of Kshar Sutra is fistulous tract. Discharge is Nil.
Track out throw and wound healed up soundly, After 20 days no pain, discharge or tenderness was observed. Complete regeneration of gluteal cushion is remarkable future of Kshar Sutra treatment