ඔබේ දිවියට ජ්යෝතිෂය…..
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Fistula-in-ano is one of the most common ailments pertaining to the ano-rectal area and has no influence on a particular race or region in its frequency of occurrence. The etiology causes of fistulain-ano have often been stressed from occupational or personal habits, but it has been observed that no occupation or habit is exempt. It is true that the agony produced by this disease lasts only for a short period and through the disease is a long lasting one, the greater part of its course is almost painless; yet there are cases on record who have been rendered socially invalid due to this condition.
The unfortunate part of the problem is that the treatment of this disease is not simple. The hazards of operative treatment are well known and at the end of a long and tedious course of therapy, the patients only knows that his fistula persists, probably in a worse condition than before. The results of operative treatment are so uncertain and the complications produced by it are so dreadful that the medical practitioner who is aware of the facts would prefer to suffer from fistulain-ano throughout his life rather than subject himself to operation.
High fistulae indeed offer the toughest challenge during their management and require a vast area of mutilation during surgery. The so- called complete fistulectomy is invariable a partial fistulectomy in these cases. It is for this reason that some surgeons prefer to perform preliminary excision of the tract followed by legating the remaining portion which gradually cuts through in due course of time. This method also is not free from the risk of complications.
The kshara sutra(medicated thread) treatment used in the field of Ayurveda surgery involves ligating the entire fistulous tract with a caustic ligature without performing an excisional therapy. This ligature is prepared by repeatedly smearing a size 20 surgical thread with certain medicinal plants caustics as described in the Ayurvedic literature. The insertion of the thread into the fistulous tract can be achieved without much difficulty with the help of specially designed instruments. The thread is changed at weekly interval and each time the length of the thread removed from the tract is measured and plotted on graph this gives an idea of the gradual progression of cutting and healing of the fistula. no probing is required for changing the ligature. A new thread is tied to the old one and is guided in to the tract by the railroad technique. Multiple fistulae can be tackled simultaneously and can be effectively treated. Before changing the thread it is important to note whether the previously created wound has healed if not changing may be postponed until the previous wound shows healing. Too rapid cutting is likely to disturb uniform healing and may leave behind a pocket resulting in recurrence. Therefore, a balance has to be maintained between the rate of cutting and healing by putting optimum pressure while tying the knot. Since the cutting and healing are coordinated in this procedure, the rate of cutting implies the sense of healing also. At the end of thread falls off spontaneously and the last one or two centimeters of the wound heals within the next few day’s time, which does not exceed one week. The resulting scar is minimal and linear as compared to the extensive mutilating scar resulting from surgery in such cases.
The goal of Kshara sutra treatment of fistula in ano by virtue of the properties of its content which has necrolytic action on tissues. During application of kshara sutra there is a continuous drainages of fistulous track and ingredients used in the thread help in healing. Kshara sutra provides continue drainage of the abscess cavity or fistula track enhancing the drainage because kshara sutra act as a foreign body in the fistula track. It has been proved as the antibacterial, antifungal and anti inflammatory action of the ksharasutra.
The effects include (a) correction of the unhealthy tissues (b) Enhancement of the healthy granulation tissue formation (c) enhancement of fibrolysis (d) separation of debris through the fistulous track (e) removal of debris and cleansing wound.
The present treatment is a definite improvement over the surgical procedure since it is free from all the above mentioned complications. The patient is ambulatory throughout the procedure and need not refrain from his work. It can be safely performed on all types of patients including hypertensive’s, diabetics and those suffering from heart disease.
Moreover, the caustic action of the thread destroys the cryptic gland completely, which is supposed to be the primary seat of origin of the fistula. In this way, the chances of recurrence after treatment by this method are negligible. It is true that the thread has ultimately to pass through the anal sphincters but it gradually cuts through these muscles and by the time the last portion of the sphincter is cut, the previously divided portion has healed. Thus, while some circular fibers of the muscle are divided, the others remain intact and while the remaining fibers are being divided, previously cut fibers become united. So, the sphincteric control is never lost in this treatment, recent research during my postgraduate studies in India(Anal Manomtery study in Fistula in Ano) revealed there were no significant reduction had found either resting or squeezed pressure after application of the kshar sutra treatment. It can be safely concluded that the treatment of ano rectal fistula by the application of caustic threads is an ideal method and is probably the best of all the known technique so far.
Currently successful clinic has been conducting to treat the ano rectal fistula at Gampaha Wickramarachchi Ayurveda Teaching Hospital, Yakkala.