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Keywords

Apamarga Ksharasutra, Ayurveda, Partial fistulectomy, Synchronized fistula in ano

Abstract

Synchronous fistula-in-ano, a rare entity with multiple fistulous tracts opening and closing simultaneously, presents significant diagnostic and surgical challenges. Conventional management may risk sphincter injury and recurrence. Ayurveda describes Ksharasutra therapy, a para-surgical intervention, which offers simultaneous cutting, drainage, and healing of fistulous tracts while preserving anal sphincter function. This case series includes three patients who presented with pain, swelling, and pus discharge from the perianal region. After detailed clinical and radiological evaluation, partial fistulectomy was performed, and Apamarga Ksharasutra was applied using the railroad technique. Postoperative care included Panchavalkala Kwatha sitz bath, Apamarga Kshara Taila dressing, Eranda Bhrishta Haritaki for bowel regulation, Varunadi Kashaya and Triphala Guggulu for postoperative support. Healing was assessed by reduction in tract length, wound condition, and symptom relief. Unit cutting time (UCT) was calculated in days/cm for each case. All three patients achieved complete wound healing within 8–9 weeks. Case 1 healed in 8 weeks with a UCT of 7.45 days/cm. Case 2 required 9 weeks with a UCT of 8.40 days/cm. Case 3 achieved closure in 8 weeks with a UCT of 7.95 days/cm. Postoperative outcomes were favourable with significant reduction in pain and discharge. No complications or recurrence were observed during follow-up. Partial fistulectomy with Ksharasutra application proved to be an effective, safe, and sphincter-preserving approach for synchronous fistula-in-ano. The consistent healing outcomes within 8–9 weeks and acceptable UCT values indicate the clinical utility of this integrative modality.

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291

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295

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