Treatment of fistula in ano by a medicated thread (Kshara sutra) of chemical curette-review and follow-up study of 182 cases

Abstract

Hippocrates described the use of seton to cure fistula in ano. The first surgical lay open of anal fistula was performed in 1337. The routine surgical treatment employed today is fistulectomy and fistulotomy. Thus, in principle the surgical treatment of fistula in ano has remained the same without much improvement. The need of prolonged hospitalization, chances of recurrence and anal incontinence in some of the cases of high level fistula have encouraged us to try out a new indigenous ambulatory treatment of fistula in ano. Treatment of 221 cases of anal fistula by application of Kshara sutra, one of the Ayurvedic treatment were performed in our clinic from July 1985 to March 1991 in Japan. Kshara sutra used in this series were prepared by Dr. Upali Pilipitiya in Sri Lanka and were cotton surgical thread impregnated with latex of Euphorbia antiquorum powder of rhizomes of Curcuma longa and alkaline powder of Achyranthes aspera. Of the 182 cases over 1 year follow-up, the youngest patient was 1 year old and the oldest was 83 years of age. The fistulous tract was cut through between 1∼5 week in average depending upon the initial length of tracts. The average of cutting was 11 mm. every week. There have been 9 patients (4.9%) of recurrence, 7 patients of pus pocket formation and a patient of slight anal deformity in the follow-up so far. Clinical experience with the 182 patients indicates that fistula in ano can be safely treated by this technique of biochemical curette with excellent results. Furthermore the recurrences and morbidity are practically negligible. Our uniformly good results suggest that biochemical medicated caustics of Kshara sutra may be responsible for the drug delivery system of chemical fistulectomy. This treatment can also be employed to severely ill patients of hypertension, diabetes and heart disease.