A CONCEPTUAL STUDY ON EXCISION OF INTERNAL FISTULOUS OPENING FOLLOWED BY APAMARGA PRATISARANEEYA KSHARAKARMA IN BHAGANDARA WITH SPECIAL REFERENCE TO FISTULA-IN-ANO

Fistula-in-ano is a chronic abnormal communication,usually lined to some degree by granulation tissue; which runs outwards from the anorectal lumen(the internal opening) to an external opening on the skin of the perineum or buttock(or rarely, in women, to the vagina).[1] Anal fistulas arise from cryptoglandular infection (90%) and systemic causes (10%).[2] The mean incidence has reported at 8.6 per 1,00,000 individuals. The prevalence is greater in men than women,with a rate of 12.3 cases per 1,00,000 and 5.6 cases per 1,00,000 respectively.[3] Modern management of Fistula-in-ano includes fistulotomy(60-70%), cutting seton (2030%), fistulectomy(10-20%), LIFT technique (Ligation of intersphincteric fistula track-10%), Advancement flaps (2-5%), Anal fistula plug repair (5%).[4] Acharya Sushruta advocates Paatana, chedana, ksharakarma and agnikarma as a line of management.[5] Ksharasutra is used for the management of Bhagandara with the efficacy of 93%-100%.It has some shortcomings such as prolonged duration of treatment in fistula with an increased tract length,pain during ksharasutra changing and requires frequent follow up.