Integrated Treatment Approach in the Management of Complex High Trans-Sphincteric Fistula-in-Ano (Bhagandara): A Case Report
DOI:
https://doi.org/10.70066/jahm.v13i10.2240Keywords:
Bhagandara, fistula-in-ano, fistulotomy, fistulectomy, Ksharasutra ligation, Case Report.Abstract
Background: Fistula-in-ano is a chronic morbid condition, usually associated with high recurrence and sphincter injuries with the conventional surgical approach. This is a unique case because of the successful outcome of the integrated approach of modern surgeries (Fistulotomy and Fistulectomy) and Ayurvedic Ksharasutra therapy, and demonstrates a patient-centered, multidisciplinary, integrated clinical approach, with preservation of the sphincter with enhanced and speedy post-procedural healing. Clinical Findings: A 57-year-old male laborer presented with chief complaints of pain, swelling, intermittent pus-draining wound near the anal region for 8 years. He had undergone two previous similar episodes, and incision and drainage were done in the past. Examination revealed three external openings at 7 o’clock, 8 o’clock, and 11 o’clock and an internal opening at 7 o’clock, with a high trans-sphincteric tract, swan neck type. Intervention: Fistulotomy and Fistulectomy were done for drainage and bland excision of the tract, followed by Ksharasutra ligation of the residual tract. Post-operative management includes intravenous antibiotics and analgesics, Internal ayurvedic medications (Triphala Guggulu, Gandhaka Rasayana, Avipattikara Churna), and Local Jatyadi Taila dressing. Ksharasutra was changed weekly, and the patient followed up regularly. Outcomes: Complete healing of the wound was achieved by the 35th Day; in addition to no post-procedural complications or recurrence were reported. Post-treatment, no discomfort was observed, and overall satisfaction was present, with preserved sphincter function. Conclusion: A chronic high trans-sphincteric fistula-in-ano was successfully managed through an integrated approach combining Fistulectomy, Fistulotomy, and Ayurvedic Ksharasutra therapy with internal and external medications. The integrative plan facilitated faster wound healing, complete sphincter preservation, and recurrence-free recovery. This case highlights the potential of a safe, effective, and evidence-based multidisciplinary protocol as a reproducible management option for complex high trans-sphincteric fistula-in-ano.
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