Interception of fistulous tract and application of Kshara Sutra: Boon for anal fistulae with scrotal extension: A case series

Abstract

Anal fistula primarily occurs due to infection of intersphincteric anal glands. In some cases, the anal fistula can extend into the scrotum. Fistula-in-ano with scrotal extension is a rare condition, and at first glance, such a presentation may be confused with acute scrotal diseases. It is commonly a congenital disorder in children characterized by painful swelling, redness, and pus discharge from the scrotum’s external opening (secondary orifice). Acharya Sushruta mentioned Ksharasutra therapy for managing Bhagandara (fistula-in-ano), a popular method for fistula-in-ano management with a reasonable success rate. Further, to fasten the recovery period in complex anal fistula cases, a modified technique of Ksharasutra is adopted, known as interception of fistulous tract with the application of Ksharasutra (IFTAK) technique. This case series describes three patients diagnosed with anal fistulae with scrotal extension. All patients had previously undergone a failed surgical procedure to cure their fistula. The patients were operated on with the IFTAK technique after proper preoperative evaluation. The postoperative fistulous wound in two cases was cured entirely within 5 weeks, and the third case within 6 weeks of treatment. IFTAK technique has shown promising outcomes in patients with anal fistula with scrotal extension. The success of the treatment with IFTAK is due to the eradication of sepsis by proper interception of the fistula tract. However, the efficacy of the IFTAK technique should be validated through well-planned randomized controlled clinical trials for its implementation as a standard treatment for complex anal fistulae.