Work

Minimal invasive Kshara Sutra technique (MIKST) for the treatment of trans-sphincteric anal fistula – a single-center retrospective study in India

Year: 2025

Type: article

Abstract: Background: Since ages, anal fistulas have posed a significant challenge for surgeons because of their unpredictable branching and high chances of recurrence after treatment. Although multiple management approaches have been introduced by skilled surgeons, none have been completely effective. In Ayurveda, a traditional Indian medical practice, Kshara Sutra (Ayurvedic seton) therapy is used to treat fistulas, but the longer this Kshara Sutra is in situ; the more pain and discomfort the patient endures. Materials and methods: This work imbibed a long-term retrospective observational study where the authors enrolled 215 patients of trans-sphincteric anal fistula who underwent a modified technique of Kshara Sutra named as MIKST, minimal invasive Kshara Sutra technique aimed to preserve anal sphincter complex and to overcome the challenging barriers faced in conventional Kshara Sutra therapy. The data are tabulated and assessed through primary outcome of healing of postoperative fistula wound, postoperative pain, number of Kshara Sutra sessions, and secondary outcome of anal incontinence and recurrence. Results: The study found a significant mean operative time of 15.307 ± 2.76 minutes and patient hospital stay of 2.16 ± 0.37 days. Postoperative pain was low, with a mean score of 1.16 ± 0.86 on the visual analog scale. The mean number of Kshara Sutra change sessions was 2.553 ± 0.81, and the unit cutting time was 5.29 ± 1.29 days/cm. The fistulous tract healed significantly after MIKST, with only one patient experiencing recurrence after 6 months, and no anal incontinence reported after a 12-month follow-up period. Conclusion: MIKST has demonstrated itself as an effective and innovative method for addressing trans-sphincteric anal fistulas having mature tracts.

Source: Annals of Medicine and Surgery

DOI: 10.1097/ms9.0000000000003048

Authors: P. Hemantha Kumar, Nasreen Hanifa

Institution: National Institute of Ayurveda

Language: English

Topic: Anorectal Disease Treatments and Outcomes

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,850