Interception and application of Ksharasutra in the management of the high anal complex fistula-in-ano – A case study

Introduction: Complex anal fistula- in- ano are those with multiple external openings; supra-sphincteric or extra-sphincteric in nature; with abscess cavity; internal opening proximal to pectinate line etc. Complex anal fistula management is associated with high recurrences and many surgical complications. There is a need of a management strategy where anal fistula is managed efficiently with very less intra and post-operative complications. Ksharasutra (Ayurvedic medicine coated surgical thread) has been practiced for years in managing anal fistula can be incorporated with interception of long and complex anal fistula to heal complex anal fistula with less post-operative adverse effects. This treatment method leads to early healing to the fistulous track and few or no post-operative complications. Methodology: A 29 years old male with one and half years history of complex high anal fistula-in-ano has been operated under saddle block where complex fistulous track was intercepted at the level of external sphincter followed by application of Ksharasutra to address crypt infection and another surgical thread was kept external to external opening to facilitate the drainage. Ksharasutra was replaced by new Ksharasutra weekly, and plain surgical thread was also changed weekly. Result: Fistulous track connected to internal opening was laid by Ksharasutra after 2 months and afterwards wound took 1 month for healing. Patient did not have any adverse events post-operatively and does not have recurrence till the date 01/03/2025. Conclusion: Ksharasutra acts as both cutting as well as draining seton which eradicates the infected anal crypts the culprit of anal fistula formation. The interception of track separates a long track into two and the treatment thus limited to managing the track connected to crypt infection i.e. internal opening and this disconnection makes distal track to collapse on its own after the thread is removed. Finding internal source of infection is vital in such cases or else recurrences can occur. Recurrence and anal incontinence are well prevented by this method of minimal surgical intervention.