COMPREHENSIVE CLINICAL REVIEW: MODERN AND AYURVEDIC PERSPECTIVES ON ANAL FISTULA AND FISSURE-IN-ANO

Anorectal disorders, specifically fistula-in-ano (Bhagandara) and fissure-in-ano (Parikartika), represent a significant portion of colorectal clinical practice. A fistula-in-ano is characterized by an abnormal epithelialized tract connecting the perianal skin to the anal canal, often arising from chronic anorectal abscesses. In contrast, a fissure-in-ano is a longitudinal tear in the distal anal canal mucosa. This review article explores the etiology, pathophysiology, and diagnostic frameworks for these conditions. Special emphasis is placed on the comparative analysis of modern surgical interventions—such as fistulotomy, fistulectomy, and LIFT (Ligation of Intersphincteric Fistula Tract)—against traditional Ayurvedic parasurgical procedures, specifically Kshar Sutra therapy. The objective is to provide a holistic management protocol that minimizes recurrence and preserves sphincter function. The review concludes that while modern diagnostics (MRI) are essential for mapping, the integration of Ayurvedic herbal management and Kshar Sutra offers a viable, minimally invasive alternative with low recurrence rates for complex cases.