1) Fistula-in-ano is a difficult surgical condition to treat due to its recurrent nature. Kshara sutra treatment is effective with benefits like low recurrence, no anesthesia or painkillers needed, and minimal tissue damage and risk of incontinence.
2) Fistulae are classified based on their tract location and can have single or multiple external openings connected to one or multiple internal openings. Kshara sutra placement involves probing the tract and threading an herbal seton.
3) Kshara sutra works both mechanically and chemically to cut the tract while promoting healing, with cutting and healing occurring simultaneously to eliminate dead space for infection.
The Research topics and reseaech areas has been explained in ail, which are helpful for Undergraduates to get the research grants, PG Scholars and Ph.D Scholars to select theirs research topics..
The Research topics and reseaech areas has been explained in ail, which are helpful for Undergraduates to get the research grants, PG Scholars and Ph.D Scholars to select theirs research topics..
Significance of Sushrutokta Chedana Karma in Bhagandaraijtsrd
Bhagandara Fistula in ano is one among the most common gudagata vikara. Bhagandara is considered as Ashtamahagada by Acharya Sushruta. It starts as a deep rooted pidaka around the guda within 2 angulas and later forms a tract with an external opening in the skin of perianal region connecting an internal opening in the skin or mucosa of anal canal or rectum lined by unhealthy granulation tissue and fibrous tissue. The main clinical features include pain, swelling around anus and pus discharge. In modern world, the medical science is so advanced in all aspects of treatments and surgical procedures but still the treatment for the Fistula in ano is not yielding satisfactory results because of its repeated recurrence rate. Acharya Sushruta has mentioned Chedana karma as main line of treatment in the management of Bhagandhara. It is the important surgical procedure explained among Ashtavidha Shastrakarma. Acharya Sushrutha mentioned different types of incisions for Chedanakarma like Langalaka, Ardhalangalaka, Sarvathobhadraka, Gothirthaka incase of Vataja Bhagandhara and Kharjura patraka, Chandrardha, Chandrachakra, Suchimukha and Avangamukha for the Kaphaja Bhagandhara. All these chedana procedures are explained for the proper excision of the fistulous track. The incisions are planned in the manner that it explores the maximum cavity of fistula including secondary track also. So, these incisions are fully valid in the modern day surgery. Dr. Mallikarjun Kokatanur | Dr. Geetanjali Hiremath | Dr. Anisha S Ashraf "Significance of Sushrutokta Chedana Karma in Bhagandara" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-7 | Issue-1 , February 2023, URL: https://www.ijtsrd.com/papers/ijtsrd52644.pdf Paper URL: https://www.ijtsrd.com/medicine/ayurvedic/52644/significance-of-sushrutokta-chedana-karma-in-bhagandara/dr-mallikarjun-kokatanur
Ksharsutra is very special Ayurvedic Treatment for Fistula in Ano .This can be called as Surgery without Knife .PPT will explain you about some important aspects of Ksharsutra Treatment .This PPT presentation is outcome of discussions with Ayurvedic well known surgeon Prof.Dr.B.N.Deshpande
• Fistula-in-ano is an abnormal connection between the epithelia zed surface of anal canal and the per anal skin.
• Anal fistula originates from the anal glands which are located between two layers of anal spinsters’ and which drain into the anal canal.
• Acc to ayurveda Anal fistula is known as bhagandar.
To Study the Efficacy of Kampillakadi Tail as- Vranaropak In Sadyovranainventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
Agnikarma is parasurgical procedure of ayurveda
The AGNIKARMA, DAHAKARMA, DAHANKARMA, DAGDHAKARMA are intentional therapeutic heat burn therapy used for the treatment of diseases caused by vata and kapha doshas..
Here definitions, indications, contraindications, materials required, methods, dahanopkarana, importance, and superiority of agnikarma are mentioned in detail.
A Review Article on Different Types of Incisions According to Sushrutaijtsrd
The field of education in medical science is traditionally divided in two branches as one medicine and other surgery. The division wasby the virtue of Agnivesha and Dhanwantarisampradaya exist in Ayurveda from early stage of human civilization.Sushruta is the major scholar of Dhanwantarisampradaaya. Acharya Sushruta laid down the fundamentals of surgery in the very first surgical text in Indian history with all the basic protocols which are still now practiced successfully. Though due to the advancement of medical science, it introduce new technique that completely transformed the practice of surgery over the period of time.Incisions are basics of surgery which has both Surgical and Anatomical importance. Surgical view of incision avoids cosmetic damage and anatomical view provide safeguard to vital structures. Acharya Sushruta stated specific incisions in relation to various parts of bodyas well as in relation to the specific diseases.There are number of incisions explained by Sushruta, like Tiryak, Chandrakara, Ardhacandhrakara, Langalak, Ardhalangalaketc.Hence an attempt made to elaborate different types of incisions told in SushrutaSamhita with their scientific validation. Anjaneya | Syeda Ather Fathima | Shivalingappa J. Arakeri | Mohasin Kadegaon | Geethanjali Hiremath "A Review Article on Different Types of Incisions According to Sushruta" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-6 , October 2021, URL: https://www.ijtsrd.com/papers/ijtsrd47661.pdf Paper URL : https://www.ijtsrd.com/medicine/ayurvedic/47661/a-review-article-on-different-types-of-incisions-according-to-sushruta/anjaneya
Fracture & dislocation is well described in Ayurveda. Sushruta Samhita have a separate chapter for bhagna etiology, features, types, prognosis, Management by name of Bhagna-Kandabhagna-Sandhimukta. The basics principles and management of fracture are accurate as per modern orthopedics.
Significance of Sushrutokta Chedana Karma in Bhagandaraijtsrd
Bhagandara Fistula in ano is one among the most common gudagata vikara. Bhagandara is considered as Ashtamahagada by Acharya Sushruta. It starts as a deep rooted pidaka around the guda within 2 angulas and later forms a tract with an external opening in the skin of perianal region connecting an internal opening in the skin or mucosa of anal canal or rectum lined by unhealthy granulation tissue and fibrous tissue. The main clinical features include pain, swelling around anus and pus discharge. In modern world, the medical science is so advanced in all aspects of treatments and surgical procedures but still the treatment for the Fistula in ano is not yielding satisfactory results because of its repeated recurrence rate. Acharya Sushruta has mentioned Chedana karma as main line of treatment in the management of Bhagandhara. It is the important surgical procedure explained among Ashtavidha Shastrakarma. Acharya Sushrutha mentioned different types of incisions for Chedanakarma like Langalaka, Ardhalangalaka, Sarvathobhadraka, Gothirthaka incase of Vataja Bhagandhara and Kharjura patraka, Chandrardha, Chandrachakra, Suchimukha and Avangamukha for the Kaphaja Bhagandhara. All these chedana procedures are explained for the proper excision of the fistulous track. The incisions are planned in the manner that it explores the maximum cavity of fistula including secondary track also. So, these incisions are fully valid in the modern day surgery. Dr. Mallikarjun Kokatanur | Dr. Geetanjali Hiremath | Dr. Anisha S Ashraf "Significance of Sushrutokta Chedana Karma in Bhagandara" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-7 | Issue-1 , February 2023, URL: https://www.ijtsrd.com/papers/ijtsrd52644.pdf Paper URL: https://www.ijtsrd.com/medicine/ayurvedic/52644/significance-of-sushrutokta-chedana-karma-in-bhagandara/dr-mallikarjun-kokatanur
Ksharsutra is very special Ayurvedic Treatment for Fistula in Ano .This can be called as Surgery without Knife .PPT will explain you about some important aspects of Ksharsutra Treatment .This PPT presentation is outcome of discussions with Ayurvedic well known surgeon Prof.Dr.B.N.Deshpande
• Fistula-in-ano is an abnormal connection between the epithelia zed surface of anal canal and the per anal skin.
• Anal fistula originates from the anal glands which are located between two layers of anal spinsters’ and which drain into the anal canal.
• Acc to ayurveda Anal fistula is known as bhagandar.
To Study the Efficacy of Kampillakadi Tail as- Vranaropak In Sadyovranainventionjournals
International Journal of Pharmaceutical Science Invention (IJPSI) is an international journal intended for professionals and researchers in all fields of Pahrmaceutical Science. IJPSI publishes research articles and reviews within the whole field Pharmacy and Pharmaceutical Science, new teaching methods, assessment, validation and the impact of new technologies and it will continue to provide information on the latest trends and developments in this ever-expanding subject. The publications of papers are selected through double peer reviewed to ensure originality, relevance, and readability. The articles published in our journal can be accessed online.
Agnikarma is parasurgical procedure of ayurveda
The AGNIKARMA, DAHAKARMA, DAHANKARMA, DAGDHAKARMA are intentional therapeutic heat burn therapy used for the treatment of diseases caused by vata and kapha doshas..
Here definitions, indications, contraindications, materials required, methods, dahanopkarana, importance, and superiority of agnikarma are mentioned in detail.
A Review Article on Different Types of Incisions According to Sushrutaijtsrd
The field of education in medical science is traditionally divided in two branches as one medicine and other surgery. The division wasby the virtue of Agnivesha and Dhanwantarisampradaya exist in Ayurveda from early stage of human civilization.Sushruta is the major scholar of Dhanwantarisampradaaya. Acharya Sushruta laid down the fundamentals of surgery in the very first surgical text in Indian history with all the basic protocols which are still now practiced successfully. Though due to the advancement of medical science, it introduce new technique that completely transformed the practice of surgery over the period of time.Incisions are basics of surgery which has both Surgical and Anatomical importance. Surgical view of incision avoids cosmetic damage and anatomical view provide safeguard to vital structures. Acharya Sushruta stated specific incisions in relation to various parts of bodyas well as in relation to the specific diseases.There are number of incisions explained by Sushruta, like Tiryak, Chandrakara, Ardhacandhrakara, Langalak, Ardhalangalaketc.Hence an attempt made to elaborate different types of incisions told in SushrutaSamhita with their scientific validation. Anjaneya | Syeda Ather Fathima | Shivalingappa J. Arakeri | Mohasin Kadegaon | Geethanjali Hiremath "A Review Article on Different Types of Incisions According to Sushruta" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-5 | Issue-6 , October 2021, URL: https://www.ijtsrd.com/papers/ijtsrd47661.pdf Paper URL : https://www.ijtsrd.com/medicine/ayurvedic/47661/a-review-article-on-different-types-of-incisions-according-to-sushruta/anjaneya
Fracture & dislocation is well described in Ayurveda. Sushruta Samhita have a separate chapter for bhagna etiology, features, types, prognosis, Management by name of Bhagna-Kandabhagna-Sandhimukta. The basics principles and management of fracture are accurate as per modern orthopedics.
Hypertonic saline and hydrogen peroxide irrigation therapy for deep seated ex...KETAN VAGHOLKAR
Deep seated residual infection following abdominal surgery is a therapeutic challenge. Administering antibiotics based on culture and sensitivity reports may not yield satisfactory results in all cases. Exact anatomical features need to be ascertained by imaging before deciding further course of treatment. Communication with ductal and luminal components of the gastrointestinal tract need to be ruled out before commencing osmotic debridement methodology. A combination of hypertonic saline and hydrogen peroxide irrigation followed by negative suction or vacuum treatment helps in obliteration and healing of deep seated infections. A case of a deep seated abscess cavity communicating with exterior managed by osmotic debridement and vacuum therapy is presented along with a brief review of literature.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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4. Fistula –in-ano is a condition
which has been recognized as a
difficult surgical disease in all the
ancient and modern medical
science of the world. It is the
recurrent nature of this disease
which makes it more and more
difficult for treatment.
5. Less recurrence rate
No need of anesthesia
No chance of anal incontinence
Less tissue damage and blood loss
No need of postoperative antibiotic and painkiller
The procedure can be applied as a day care
No need of specific dressing
6. Tract lined by granulation tissue which connects
deeply in the anal canal or rectum and
superficially on the skin around the anus
11. Relates to track between
two opening
Anterior –straight up to
3.75cms.
Posterior-curved
12. Digital Examination
Not infrequently a internal opening can be felt as a
nodule on the wall of the anal canal.
Irrespective of the number of external openings, there is
almost invariably only one internal opening.
Proctoscopy
Sometimes will reveal the internal opening of the fistula.
A hyper trophied papilla is suggestive that the internal
opening lies within the crypt related to papilla.
13. Probing :
Probing is painful and is liable to rewaken dormant
infection.
If patient is experiencing pain, makes a sudden jerk,
a false passage may result.
Probing should be postponed until the patient is
under anaesthesia.
14. Fistulography :-
Very useful for recurrent fistulae.
Fistulae with multiple opening.
High Level Fistula
Fistula of long duration
Ramification of fistula are suspected
Horse Shoe fistula
When origin of the fistula lies elsewhere
Injection of Lipiodol or other medium along
the sinus, before radiography is some time
likely cause a recrudescence of inflammation
15. Endoluminal Ultrasonography, Magnetic resonance imaging and
X-Ray
These two are being developed as techniques for mapping complex
fistulae, showing good results.
Radiography of the thorax should be undertaken if possibility of
pulmonary tuberculosis is considered.
Routine investigation.
Routine Blood and Urine Examination should be undertaken.
Special Investigation.
Systemic and associated causes like diabetes mellitus, tuberculosis,
Ch. Ulcerative Colitis, Diverticulosis of the Colon, Prostatic infection
and Crohn’s disease should be ruled out by special investigations.
16.
17. Written consent
Anti tetanus as prophylaxis.
Lidocain sensitivity test.
Preparation of the part.
a. Shaving of the operative part.
b. Painting of the operative part.
18. Position – Lithotomy
Procedure of Kshara-Sootra tecnhique-
Step I
Probing – Two conditions
Where there are two openings
i) Proximal ii) Distal
When there is one opening
i) Proximal
19. A suitable size of probe is negotiated and
advanced through the proximal opening along the
path of least resistance and withdraw the probe
from the distal opening.
20. A suitable size of probe is negotiated and advanced
through the proximal opening along the path of least
resistance and gently create a distal opening to
withdraw the probe.
21. Step II
A seton of suitable length and size is placed in the eye
of probe and the probe is pulled out through distal
opening, in order to position the seton in the tract.
Both ends of the seton tied loosely outside the tract.
22. Dressing of the wound with medicated oil.
Application of bandage.
23. Step –IV
Technique for changing of Ksharsutra
Application of Ksharasutra after 3 or 7 days by Rail Road Technique.
New Ksharasutra is tied to the lateral side of knot.
Thread is cut between the knot and clipped artery forceps.
Artery forceps is gently pulled out along with the old thread such that
thread (old) comes out leaving the new ksharasutra in tract.
Cut old Ksharasutra and ends of the new one are tied firmly.
Cotton soaked in Anu Taila is placed locally and bandage applied.
24. Nil orally up to 3 hours.
Analgesics as per required.
Shothahara drugs as guggulu.
Hot sitz bath
26. Wire on ice block
bearing weight
both side
Mechanism of Kshara Sutra
Wire cutting
through by
pressure
Ice block
reform and
healed block
27. 1. Latex of Euphorbia (Snuhi) is proteolytic, therefore,
dissolves the fibrous tissue of Fistulous tract.
2. Apamarg Kshar is a Alkali, which clears the fistulous
tract and liquidates the thick pus. It keeps the tract
clean and helps in drainage of pus. It causes chemical
fistulectomy.
3. Turmeric powder is anti-allergic, anti septic and a
wound healer.
28. 4. Special linen thread holds the medicines with the
help of latex for 3-4 days in the fistulous tract.
5. Physical presence of Ksharsutra in the fistulous
tract keeps the passage patent and helps in the
drainage of pus.
6. Ksharsutra legation exerts mechanical pressure
along with chemical cauterization. Therefore, in
the initial 3 days there is cutting of the tract.
29. 7. After cutting the fistulous tract by Ksharsutra
in initial days the follow-up of 3-4 days is the
healing time for the wound.
8. As cutting and healing go side by side, there
is no gap or recess for accumulation of pus
in the cavity.
9. In case the abscess cavity is large -
Ksharsutra can be packed in the cavity till all
the accumulated pus is drained out and
wound is clean for healing.
30. 10. Keeping in view the healing progress of the
tract – surgeon can tight or loose the
Ksharsutra ligation.
11. Alkali of Ksharsutra when applied with
medicated oil it forms soap, which cleans the
tract.
31. Hence we can conclude that the Kshar sutra
therapy is a ‘chemical fistulectomy ‘ rather than a
surgical ‘fistulectomy ‘ proved to be free from
complications.
The application of Kshar sutra in to fistulous
tract was capable of dissolving the tough fibrous
tissue and ultimately draining it out creating a
healthy base of healing.
The ksharsutra treatment of fistula in ano is now
an accepted technique and has also found a
place in the text books of colorectal surgery.
32. Fistula with multiple external opening
Causes
Some times superficial healing of
single external opening occurs,
pus accumulate and abscess
reforms and discharges through
another opening. In this way
multiple opening are created,
though the fistula is free of any
associated cause like -
Tuberculosis Proctitis.
Crohn’s Disease of the colon
Lymphogranuloma Venereum.
Bilharziasis
Multiple fistulae
33. Treatment of Fistula in ano with
multiple external opening
To exclude Tuberculosis, Crohn’s disease, Bilharziasis and
Lymphogranuloma Venereum and treat accordingly. Fistula will also
respond to the treatment.
If no specific pathology is found, Ksharsutra ligation is undertaken.
Method :
If main tract is connected to single internal opening and other tracts
joins to the main tract and to each other, then Ksharsutra is placed in
the main tract and other tract are join to each other and to the main
tract with separate Ksharsutra.
If it is not possible to connect multiple opening with each other or to
the main tract because of the depth of tracts then they are connected
with the same internal opening separately.
34. These threads partly traverse through the separate tracks while in
the deeper part they traverse together in the same tract.
These threads usually cut through the internal and external sphincter
at the same place and because the cutting and healing go slowly and
simultaneously the development of incontinence is not appreciable .
Multiple openings with separate fistulous tract creating multiple
internal opening .
Each fistulous tract is threaded separately in such a way that no two
threads pass through the sphincter at the same time because if the
sphincter is cut at two places in the same period, its fibres will
contract and may lead to incontinence. Hence the timing of the
thread should be adjusted in such a manner that only one thread cut
through the sphincter at one time
36. Horse Shoe Fistula
It is a type of high anal fistula with two external opening usually on the
posterior half of the anal orifice on either side of midline.
The track is usually curved and open with single internal opening at 6
O clock position in the anal canal posteriorly.
37. Recurrent Fistula in Ano
Causes
Faulty surgical technique where in some branch of the main fistulous
track has been over looked.
Persistent infection in the fistulous track for long long time.
Specific diseases like TB, Crohn’s Disease, Ulcerative Colitis, Carcinoma
Rectum etc are being over looked previously.
Immuno Compromised patients like Diabetes Mellitus, HIV etc.
Jaundice and Uraemia patients because of poor wound healing as
fibroblastic repair is delayed in them.
Patients with Malnutrition, Deficiency of Vitamin C and zinc, heralds the
synthesis and maintenance of collagen.
Patient on Cytotoxic drugs
Patients on Corticosterioid
Patient suffering from any generalized infective disorder.
These all factors affect healing process so that we get a immature scar
tissue and recurrence is always possible.
38. Treatment
Surgery is not indicated in these
cases.
Because repeated surgery
amounts to lot of fibrosis so
much that the entire soft cusion
of pad of fat is turned into hard
fibrous tissue making the
application of Ksharsutra and
latter initiation of healing process
more and more difficult
39. Long Perineal Fistula
External opening is sometimes located in
perineal area below the scrotum.
This fistula is generally of high anal
variety with tract running a direct course
and internal opening is found in the
anterior half of the anal canal, above the
dentate line.
Other conditions like periuretheric
abscess because of severe urithritis,
prostatic abscess because of acute
prostatitis, Tuberculosis of the prostate
and seminal vesicles which results into
cold abscess and may rupture into the
anal canal or rectum creating a fistulous
tract should also be kept in mind.
Ksharsutra ligation is carried out in these
fistulae excluding the above associated
causes.
40. Blind Internal Fistula
These are the fistulae where internal opening get closed
somehow,
These are of intersphincteric variety of fistulae running straight
course.
Probing has to be done very cautiously as it can easily be
converted into high level fistula where in a false internal opening
is created above the ano rectal bundle.
Ksharsutra can be applied in these fistula by creating an internal
opening at the level of dentate line which will be the seat of
primary internal opening
41. Blind External Fistula
Usually the patient with the
history of painful purulent
discharge per anum.
No external opening is found.
An indurated fistulous tract
may sometimes be palpable.
Treatment
Ksharsutra ligation can be
done by probing the tract in a
retrograde fashion usually, the
tip of the probe is felt under
the skin and a small nick is
made to create an external
opening.
42. Fistula connected with Chronic
Anal Fissure
It is a complication of chronic anal fissure.
Fissure heals superficially leaving a potential space underneath.
Infection persist in that space leading to chronic inflammatory
condition, suppuration and abscess formation which burst or
rupture resulting into Fistula formation.
External opening is usually hidden under the sentinel tag. Internal
opening is found at dentate line which is the upper end of the
fissure.
Pain and purulent discharge are the leading features
Exclude Crohn’s Disease if the patient is European / North
American as fissure is generally associated with this disorder.
43. Treatment
Whole of the fistula tract along with sentinel tag and
fissure and can be excised without any fear of
incontinence
Ksharsutra ligation can be applied