Minimally Invasive Management of Horseshoe Fistula-in-ano: A Case Series on the Efficacy of Interception of Fistulous Tract with Application of Ksharasutra

A BSTRACT Horseshoe fistula is a complex variant of fistula-in-ano with bilateral extensions that often presents diagnostic and therapeutic challenges. This case series aimed to evaluate the effectiveness of the Interception of Fistulous Tract with Application of Ksharasutra (IFTAK) technique, a minimally invasive and sphincter-preserving modality, in the management of horseshoe fistula-in-ano. Despite multiple surgical options, recurrence and sphincter dysfunction remain significant concerns in conventional management. This prospective, single-center, nonconsecutive case series conducted at a teaching and research institution included five patients diagnosed with horseshoe fistula-in-ano who were treated using the IFTAK technique between 2020 and 2024. Postoperative care consisted of daily sitz baths, local application of Jatyadi Taila, and oral Triphala Guggulu tablets until complete healing. Patients were followed for one year to assess healing, complications, and recurrence. All patients reported marked symptom relief, with complete resolution of external openings at a mean of 8 days. The average cut-through time was 27 days, and complete healing was achieved at a mean of 41 days. No recurrence or incontinence was observed during the one-year follow-up period. The findings indicate that the IFTAK technique, combined with supportive Ayurvedic therapies, effectively manages horseshoe fistula-in-ano while preserving sphincter function, expediting healing, and reducing the risk of recurrence. This minimally invasive approach shows promise as an alternative to conventional surgical methods; however, further studies are warranted to validate these findings.