Comparing Ksharasutra (Ayurvedic Seton) and open fistulotomy in the management of fistula-in-ano.
BACKGROUND
Most commonly practiced surgical "lay open" technique to treat fistula-in-ano (a common anorectal pathology) has high rate of recurrence and anal incontinence. Alternatively, a nonsurgical cost efficient treatment with Ksharasutra (cotton Seton coated with Ayurvedic medicines) has minimal complications. In our study, we have tried to compare these two techniques.


METHODS
A prospective randomized control study was designed involving patients referred to the Department of General Surgery in RG Kar Medical College, Kolkata, India, from January 2010 to September 2011.


RESULTS
Among 50 patients, 26 were in Ksharasutra and 24 were in fistulotomy group. 86% patients were male and 54% of the patients were in the fourth decade. About 74% fistulas are inter-sphincteric and 26% were of trans-sphincteric variety. Severe postoperative pain was more (7.7% vs. 25%) in fistulotomy group, while wound discharge was more associated with Ksharasutra group (15.3% vs. 8.3%). Wound scarring, bleeding, and infection rate were similar in both groups. Ksharasutra group took more time to heal (mean: 53 vs. 35.7 days, P = 0.002) despite reduced disruption to their routine work (2.7 vs. 15.5 days work off, P <0.001). Interestingly, pain experienced was less in Ksharasutra group, there was no open wound in contrast to fistulotomy and it was significantly cost effective (Rupees 166 vs. 464).


CONCLUSIONS
Treatment of fistula-in-ano with Ksharasutra is a simple with low complications and minimal cost.
Department of Plastic Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India.
Gouranga
G
Dutta
Department of Plastic Surgery, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India.
Jayanta
J
Bain
Department of General Surgery, Murshidabad Medical College and Hospital, Murshidabad, West Bengal, India.
Ajay Kumar
AK
Ray
Department of Anatomy, Calcutta National Medical College and Chittaranjan Hospital, Kolkata, West Bengal, India.
Soumedhik
S
Dey
Department of Hematology, ESI-PGIMSR and Medical College, Kolkata, West Bengal, India.
Nandini
N
Das
Department of Pediatric Surgery, NRS Medical College and Hospital, Kolkata, West Bengal, India.
Biswanath
B
Das
Fistula-in-ano; Ksharasutra; Seton; fistulotomy