title: Comparative study of Ksharasutra suturing and Lord's anal dilatation in the management of Parikartika (chronic fissure-in-ano).
abstract: BACKGROUND
  Parikartika resembles fissure-in-ano which is very common among all ano-rectal disorders. In Ayurvedic texts, Parikartika is described as a complication of Vamana and Virechana as well as complication of Atisara. Ksharasutra was proved successful in the management of fistula-in-ano, piles, and there is a need to try its efficacy in fissure-in-ano.
  
  
  OBJECTIVE
  To evaluate the role of Ksharasutra suturing (KSS) in fissure bed in chronic fissure-in-ano.
  
  
  METHODS
  Total 100 patients of chronic fissure-in-ano were selected and randomly divided into two groups (50 in each group). In group-A, patients were undergone by KSS; while in patients of Group-B Lord's anal dilatation followed by KSS was done under spinal anesthesia. The KSS was done once and after slough out of Ksharasutra, the wound was treated for 4 weeks and assessment of the result was done on the basis of gradation adopted.
  
  
  RESULTS
  The pain relief on 14(th) day in Group-A was 86% while in Group-B 100% was observed. As on 7(th) day in Group-A, oozing was stopped in 68% patients, while in Group-B, oozing was stopped in 82% patients. On 21(st) day, Group-B showed more healing (85%) as compared to Group-A (69%). In this study 68% of patients were cured.
  
  
  CONCLUSIONS
  In Group-B (KSS with Lord's anal dilatation) patients were cured early as compared to patients of Group-A (KSS alone).
authors.affiliation: Department of Shalya Tantra, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India.
authors.forename: Tukaram S
authors.initials: TS
authors.lastname: Dudhamal
authors.affiliation: Department of Shalya Tantra, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India.
authors.forename: Madhav Singh
authors.initials: MS
authors.lastname: Baghel
authors.affiliation: Center for Care of Ano-Rectum Research by Indian System of Medicine and Allied (CCARRISMA), Bhubaneswar, Odisha, India.
authors.forename: Chaturbhuja
authors.initials: C
authors.lastname: Bhuyan
authors.affiliation: Department of Shalya Tantra, Institute for Post Graduate Teaching and Research in Ayurveda, Gujarat Ayurved University, Jamnagar, Gujarat, India.
authors.forename: Sanjay Kumar
authors.initials: SK
authors.lastname: Gupta
keywords: Fissure-in-ano; Ksharasutra; Lord's anal dilatation; Parikartika