Management of Complex Trans-Sphincteric Fistula with Anterior Horseshoe Abscess Using the IFTAK Technique: An Ayurvedic Case Report

Background: A fistula-in-ano is a chronic granulation tissue-lined tract connecting the anorectal canal to the perianal skin. Complex fistulas are associated with higher recurrence rates and increased risk of sphincter damage during surgical intervention. In Āyurveda, this condition is described as Bhagandara, for which Kṣārasūtra therapy is considered an effective parasurgical intervention. Recently, the minimally invasive IFTAK technique has gained attention in managing complex cases. Case Presentation: A 29-year-old male presented with perianal pain, swelling, and intermittent purulent discharge, with clinical examination and MRI revealing an anterior horseshoe abscess with a complex trans-sphincteric fistula. The patient was managed with the IFTAK technique combined with Kṣārasūtra therapy, along with internal Ayurvedic administration. Outcome: Gradual reduction in pain, discharge, and inflammation was observed. Sequential Kṣārasūtra changes facilitated progressive tract healing, with follow-up MRI confirming complete resolution without recurrence. Conclusion: The IFTAK approach combined with Kṣārasūtra therapy appears to be a safe, effective, and sphincter-preserving modality for managing complex fistula-in-ano. Keywords: Complex fistula, Bhagandara, Kṣārasūtra, IFTAK, Fistula-in-ano