A case report on the management of fistula-in-ano by modified conventional ksharasutra therapy: A sphincter-saving technique

Introduction: Fistula in ano is one of the challenging diseases due to the lack of ideal treatment modalities and its high rate of recurrence. Fistulas with multiple openings are very difficult to manage considering the preservation of sphincter muscles. Modern science has developed many techniques in this area but mostly all were failures and resulted in complications like anal incontinence. Ksharasutra therapy is accepted worldwide as the ideal treatment modality of fistula in ano by its simultaneous cutting and healing property. Main Clinical Findings and Diagnosis: In this case, a 37 year old male patient presented with complaints of swelling over the right perianal area and intermittent pus discharge from that swelling for 1 year. On local examination, there were two external openings at 10 and 11'O clock position 4 cm away from the anal verge and a sentinel tag at 6'O clock position. Per rectal examination revealed induration and tenderness at 11'O clock above the dentate line. Intervention: It was managed by a new sphincter saving technique, modified conventional Ksharasutra therapy to fasten the recovery period and minimize the postsurgical pain. Conclusion: Fistula was completely healed by 5 weeks. No complications reported from the patient and no recurrence was happened after 6 months of follow up.