Partial-fistulectomy and Ksharasutra application in the management of complicated fistula-Clinical images
Under the spinal anesthesia painting draping done and methylene dye was passed through one external opening to identify the course of track during procedure (Figure-2-3). Probing was done (Figure-4) and coring of complete fistulous tract was done up to sphincter (Figure-5-6). After partial fistulectomy the Ksharasutra was applied in reaming tract (3 to 3 o clock and 4 to 6 o clock) to preserve the sphincter (Figure-8).
Post-operative IV fluids (2 days) antibiotics and analgesic (7 days) and multivitamins (2 months) were given. Along with this sitz bath with Panchavalkal (daily), laxative (at night) and dressing with Jatyadi taila (daily once) and Ksharasutra change (weekly once) was done till complete recovery. The post operative progress was well that is wound healing was going normally and cutting of remaining tract was 0.5 cm weekly as shown in the Figures-9-13. Follow up was done after one and half year and there was no recurrence (Figure-14). Finally the case was cured completely and patient enjoying his quality of life without any complication and recurrence. Hence this clinical images showed that the integrative approach of partial fistulectomy and Ksharasutra provide early recovery without recurrence.