A Pilot Study on Udumbara Hsheera Based Kshara Sutra with Partial Fistulectomy in Bhagandra (fistula - in ano)

Abstract

In Ayurveda, Bhagandara (Fistula-in-ano) is considered under the heading of Ashtamahagada (eight major diseases) due to its notorious nature. Ksharasutra is a medicated thread, indicated in ano-rectal diseases, particularly for management of Bhagandara (Fistula-in-ano). Now a days in some researchers different Ksharasutra are being tried like Guggulu based, Snuhi Ksheera, Shallaki Ksheera based etc. In this study Udumbara Ksheera based Ksharasutra was tried in the management of Bhagandara. It was prepared with Udumbara Ksheera (Ficus racemose), Apamarga Kshara (Ash of Achyranthus aspera Linn) and Turmeric powder (Curcuma longa Linn) as per the guideline of Ayurveda Pharmacopeia. Here Guggul is replaced with Udumbara Ksheera. In this pilot study 10 patients of Bhagandara were selected from Shalya Clinic and treated with Partial Fistulectomy followed by Udumbara Ksheera based Ksharasutra application in remaining part of the tract under local anesthesia. From next day, sitz bath with Panchawalkala Kwatha, dressing with Rogan-e-kash and per rectal instillation of 10 ml Sarvavishadi Oil was done daily. Ksharasutra was changed with a new one by rail-road technique on weekly interval and the length of thread as well as the condition of wound was noted to assess the unit cutting time (UCT) and healing till the complete healing of fistulous tract was achieved. After 5 days of the procedure, healthy granulated wound was seen. Average UCT of fistulous tract was 7.51 days/cm. Complete cutting and healing of fistulous tract was occurred within one and half month in 5 patients. In 2 patients time required for complete healing was 2 months while in 3 patients it was 4 months. Management of a long fistulous track by Ksharasutra is very tedious job. In this study fistulous tract was partially excised and that's why there is early healing of fistulous tract was occurred as compare to Ksharasutra application without doing partial Fistulectomy Udumbara Ksheera based Ksharasutra have shown less burning pain and compare to Snuhi based Ksharasutra due to anti-inflammatory and less irritant property of Udumbara Ksheera. The positive finding in this study is the time required for complete healing was less as compared to Snuhi based Ksharasutra.

The cutting and healing of fistulous tract and healing of post partial fistulectomy wound was taken placed simultaneously. This pilot study demonstrated the utility of Partial Fistulectomy and Udumbara Ksheera based Ksharasutra in management of Bhagandara in which have a lesser amount of pain and less time is required to heal fistulous tract completely.