Management of Intersphincteric Fistula with Ksharasutra using the Samsung Medical Center Knot along with Oral Medicines: A Case Report

Abstract

Fistula-in-Ano is a condition characterized by an abnormal connection between the anal canal and the external epithelium. Ksharasutra therapy has been a minimally invasive treatment in the management for fistula-in-Ano. Conventionally it is applied using a reef knot. And internalization of the external opening after few weeks of cutting through the tissues can create difficulty in proper application of the ksharasutra. Samsung medical center knot (SMC Knot) is used in laparoscopic and arthroscopic surgeries for extracorporeal knot tying. A 49-year-old male with an intersphincteric fistula underwent Ksharasutra therapy. The internalization of the external opening after two weeks complicated the thread replacement as well as providing optimum tension. The SMC knot was applied in this case. It allowed extracorporeal tying of the knot and could slide in to position to provide desired tension. The result demonstrates that the cutting efficiency was enhanced post- SMC knot application. This case highlights the integration of surgical methods into Ayurvedic practices which can enhance adaptability of ksharasutra therapy for personalized treatments and provide better outcomes.