A COMPARATIVE CLINICAL STUDY OF ARKA KSHARA SUTRA AND APAMARGA KSHARA SUTRA IN THE MANAGEMENT OF BHAGANDARA(FISTULA IN ANO). Dr. narendrasinh thakor

Dr. narendrasinh thakor 1 , Dr. nilesh jethva 2 and Dr. hemant Toshikhane 3 . 1. pg scholar dept.of shalya tantra parul institute of ayurved,Vadodara. 2. co-guide parul institute of ayurved,Vadodara. 3. guide parul institute of ayurved,Vadodara. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


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Inclusion Criteria:- Clinical signs and symptom of all types of Bhaganadara.  Patient above 20yrs and below 70 yrs Exclusion Criteria:- HIV and HBsAg positive patients.  Uncontrolled Diabetes Mellitus.  Patients group of ages below 20yrs and above 70yrs.  Patients who are not ready to sign written informed consent form.  Secondary fistula due to a) Ulcerative colitis b) Chron"s disease c) Tuberculosis d) Carcinoma of rectum and anal canal.

Application of arka and apamarga-Kshara Sutra:-
The patient is kept in proper lithotomy position and perianal region was cleaned with antiseptic lotions and draped. Patient is reassured and gloved finger was gently introduced into the rectum. Then a probe was passed through the external opening of fistula. The tip of the probe was forwarded along the path of least resistance and was guided by 168 the finger in rectum to reach into the lumen of anal canal through the internal opening and its tip was finally directed to come out of anal orifice. Then a suitable length of Plain surgical linen thread no.20 was taken and threaded into the eye of probe. Thereafter the probe was pulled out through the anal orifice, to leave the thread behind in the fistulous track. The two ends of the thread were then tied together with a moderate tightness outside the anal canal. This procedure is called primary threading and on second day post-operative day the arka and apamarga-Kshara Sutra application is done.
Change of Kshara Sutra:-All patients were instructed to take hot sitz bath before changing the thread. The Kshara Sutra was changed at weekly interval. The thread is tied to the previously applied Kshara Sutra in position towards outer end of the knot. Then an artery forceps is applied inner end to the same knot. Then the old thread is cut between the artery forceps and the knot. Pulling of the artery forceps along with the thread ultimately replaces the old thread by Kshara Sutra. Then the two ends are ligated and bandaging was done. This procedure is done by Railroad technique. The same procedure is followed for successive changes of Kshara Sutra at weekly interval.

Follow-up:-
All the patients were instructed to visit Ano-rectal clinic once in a week till the complete cut through of the fistulous tract. Cases, attended in Dept. of P.G.Studies in Shalyatantra, parul institute of ayurvedlimda, divided into two groups, control group Apamarga Kshara Sutra was applied, while in trial group Arka Kshara Sutra was applied after establishing the diagnosis of Bhagandara. All 40 patients of Bhagandara have been analysied for age, sex, habitat, socio-economic status, doshicprakriti, type of Bhagandara, type of fistula, chronicity of disease, position of external openings, length of the fistulous track, clinical findings, unit cutting time etc were observed and noted. The Unit cutting time means the time taken by Kshara Sutra to cut one cm of fistulous track in days. This was calculated using the formula.

Observations and Results:-
U.C.T. = Total number of days taken for cut through = …. days/cm Initial length of track in cms  175

Nature of bowel habits:-
In the present study nature of bowel habits were broadly classified into 2 groups.The maximum numbers were found with 26 cases constipated,13 cases irregular we found.  180 Level of fistula:-• Analysis of 39 patients of level of Fistula-in-ano was made. The maximum 95% patient were suffering from low anal fistula and 5% high anal fistula.

Conclusion:-
Aim of present study is to find out the efficacy and applicability of ArkaksharaSutra in the management of Bhagandara. Based on the above clinical statistical data it may be concluded as follows- There was a marked reduction of symptoms of irritation, inflammation, and local reactions in treated group as compared to control group.  Economically minimised the problems of preparation.  Wound healing after cut through was faster in treated group(1-2 weeks) as compared to (2-3 weeks) in control group.  No recurrences of cases were reported during the last 6 months of follow up.  Easy Availability and Collection