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Minimally Invasive Window Technique for Horseshoe Fistula: Case Report

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Journal name: Ayushdhara
Original article title: A Minimal Invasive Surgical Procedure (Window Technique) for the Management of Sambukavrata Bhagandara (Horseshoe Shape Fistula In Ano): A Case Report
AYUSHDHARA is an international peer-reviewed journal. It focuses on research in Ayurveda, Yoga, Unani, Siddha, Homeopathy, Allopathy, and Pharmaceutical Sciences.
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Author(s):

Lokendra Pahadiya
Assistant Professor, PG Department of Shalya Tantra, NIA, Jaipur, India
P. Hemantha Kumar
Professor & Head, PG Department of Shalya Tantra, NIA, Jaipur, India
Ashok Kumar
Associate Professor, PG Department of Shalya Tantra, NIA, Jaipur, India
Narinder Singh
Associate Professor, PG Department of Shalya Tantra, NIA, Jaipur, India


Ayushdhara:

(A peer-reviewed, bi-monthly open-access journal)

Full text available for: A Minimal Invasive Surgical Procedure (Window Technique) for the Management of Sambukavrata Bhagandara (Horseshoe Shape Fistula In Ano): A Case Report

Year: 2021 | Doi: 10.47070/ayushdhara.v8i6.821

Copyright (license): CC BY-NC-SA 4.0


Download the PDF file of the original publication


Summary of article contents:

Introduction

The paper presents a case study of a 62-year-old male patient diagnosed with Sambukavarta Bhagandara, commonly known as horseshoe-shaped fistula in ano. This condition, as described in ancient Ayurvedic texts by Acharya Sushruta, is complex and classified as “Asadhyaya,� meaning it is difficult to treat due to its involvement with all three doshas. Despite the availability of various treatment modalities for anal fistulas, recurrence rates remain significant, necessitating the exploration of minimally invasive surgical techniques. This study details a novel surgical approach called the Window technique, combined with Kshara Sutra therapy, aimed at improved management outcomes.

Window Technique and Its Benefits

The Window technique is a minimal invasive surgical procedure designed to effectively manage complicated cases of fistula in ano, particularly Sambukavarta Bhagandara. This technique involves the strategic creation of a 'window' to access and divide the fistulous tract, allowing for proper drainage and treatment of infected areas. By incorporating Kshara Sutra technology, which utilizes alkali-based treatment to destroy unhealthy tissue, this approach not only minimizes tissue damage but also promotes faster healing. The results indicated that patients experienced reduced postoperative pain, shorter hospital stays, and improved return to daily activities, all while significantly lowering the risk of recurrence compared to traditional methods.

Treatment Protocol and Postoperative Management

The treatment protocol for this patient involved meticulous preoperative preparation, including local anesthesia and thorough examination of the fistulous tract. A comprehensive set of surgical instruments was utilized, and upon identifying the internal opening of the fistula, the Window technique was performed. Postoperatively, the patient received care involving regular dressing with Jatyadi Taila and weekly changes of Kshara Sutra to support the healing process. Follow-ups demonstrated a swift resolution of symptoms, with inflammation and discharge significantly reduced by the second week and complete recovery achieved without further complications by the end of four weeks.

Conclusion

The findings of this case study suggest that the Window technique is a viable and effective treatment option for horseshoe-shaped fistula in ano, offering multiple advantages over traditional approaches. It results in less invasive procedures, minimal scarring, reduced pain, and quicker recovery times, thus lessening the overall impact on the patient's quality of life. However, the authors recommend conducting further studies with larger patient samples to validate the efficacy and generalizability of this technique in managing similar complicated anal fistulas.

FAQ section (important questions/answers):

What is Sambukavarta Bhagandara and how is it treated?

Sambukavarta Bhagandara, also known as horseshoe-shaped fistula in ano, is a challenging condition often treated with traditional methods. The Window technique, a minimal invasive surgical procedure, is proposed as an effective approach for managing this condition, resulting in reduced pain and scarring.

What are the benefits of using the Window technique?

The Window technique for treating fistula in ano is less time-consuming, causes minimal postoperative pain, ensures shorter hospital stays, results in minimal scar tissue, and decreases recurrence rates. It enables quicker recovery and early return to normal activities.

What postoperative care is recommended after the Window technique?

Postoperative care includes regular dressing with Jatyadi Taila to promote healing and weekly changes of Kshara Sutra. Patients are advised to follow up for monitoring symptoms such as pain and discharge, ensuring a smooth recovery process.

Glossary definitions and references:

Scientific and Ayurvedic Glossary list for “Minimally Invasive Window Technique for Horseshoe Fistula: Case Report�. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.

1) Bhagandara (Bhagamdara):
Bhagandara is a medical condition characterized by tears or ruptures in the regions of the vagina, anorectum, pubic, and perianal areas. Acharya Sushruta mentioned this disease as Kricchsadhyaya (difficult to treat) or Asadhyaya (not curable), making it a challenging condition to manage.

2) Sutra:
In this context, Sutra refers to the therapeutic thread used in Ayurvedic medicine, particularly in Kshara Sutra therapy, which involves a medicated thread to treat fistulas. The thread helps in cutting, draining, and healing the fistulous tract, reducing post-operative pain and minimizing the chances of recurrence.

3) Ksharasutra (Ksarasutra, Kshara-sutra):
Kshara-sutra is a specialized Ayurvedic treatment involving the use of medicated threads to treat conditions like Bhagandara (fistula in ano). The threads are coated with herbal medicines, which help in cutting and healing the fistulous tract over time while minimizing tissue damage and scarring.

4) Kshara (Ksara):
Kshara, in Ayurveda, refers to an alkaline substance used for its cauterizing and debriding properties. In the treatment of Bhagandara, Kshara is applied via Kshara Sutra to chemically cauterize the fistulous tract, promoting debridement of unhealthy tissues and aiding in the healing process.

5) Horse:
The term 'Horse' in this document is part of 'horse shoe shape' used to describe a specific type of Bhagandara or fistula in ano. This shape indicates a fistulous tract configuration that curves around, making treatment more complex.

6) Disease:
The document discusses a specific disease called Bhagandara, which is a type of fistula that affects the perianal region. It describes various traditional and modern techniques used to manage this condition, which is known for its high recurrence rate and challenging nature to treat.

7) Pain:
Pain is a common symptom for patients suffering from Bhagandara, often associated with boils in the perianal region. Effective treatment aims to minimize post-operative pain, which is a key factor considered in the described minimal invasive surgical procedures like the Window Technique.

8) Inflammation:
Inflammation is a typical symptom in patients with Bhagandara, characterized by swelling, tenderness, and redness in the perianal region. Successful treatment reduces inflammation, as noted in the case study where symptoms subsided significantly within 2-3 weeks after applying the Window Technique combined with Kshara Sutra.

9) Lokendra:
Lokendra Pahadiya is one of the authors of the study and an Assistant Professor in the PG Department of Shalya Tantra at NIA, Jaipur. His research focuses on minimal invasive surgical procedures for the management of conditions like Bhagandara using traditional Ayurvedic techniques.

10) Shalya (Salya):
Shalya refers to surgery and surgical practices in Ayurveda. Shalya Tantra is the branch of Ayurveda dealing with surgical procedures. The document describes a minimal invasive surgical procedure (Window Technique) for managing Sambukavarta Bhagandara, showcasing the integration of traditional Ayurvedic practices with modern surgical methods.

11) Jatyadi:
Jatyadi is part of Jatyadi Taila, an Ayurvedic medicinal oil used for wound healing. In the context of Bhagandara treatment, regular dressing with Jatyadi Taila promotes healing, reduces secretions, and helps in managing symptoms effectively due to its Katu-Tikta Rasa (pungent-bitter taste) and Shodhan-Ropana (cleansing and healing) properties.

12) Pidika:
Pidika refers to a boil or abscess in Ayurvedic terms. Initially, the disease starts as Pidika in the perianal region, and when it bursts, it is known as Bhagandara. Proper treatment is necessary to avoid the progression from Pidika to complicated fistula.

13) Karma (Karman):
Karma in this context refers to Shalya Karma, which means surgical actions or procedures. The document details a specific Shalya Karma called the Window Technique used to treat Bhagandara, highlighting the surgical steps and post-operative care to ensure effective healing and minimal recurrence.

14) Taila (Thaila):
Taila refers to medicinal oil used in Ayurvedic treatments. The document specifically mentions Jatyadi Taila, which is used for postoperative dressings to promote wound healing in patients treated for Bhagandara. The oil's healing properties help reduce inflammation and accelerate recovery.

15) Kumar:
Kumar in this document refers to P. Hemantha Kumar, one of the co-authors of the study. He is a Professor and Head of the PG Department of Shalya Tantra at NIA, Jaipur, contributing to the research on minimal invasive surgical treatments for conditions like Bhagandara using Ayurvedic techniques.

16) Gold (Golden):
The term 'gold' in this context refers to the 'gold standard' mentioned in the document. It describes Kshara Sutra therapy as the gold standard technique for treating Bhagandara, indicating its high effectiveness and established use in Ayurvedic medicine for managing fistulas.

17) Triphalaguggulu (Triphala-guggulu):
TriphalaGuggulu is an Ayurvedic medicine consisting of Triphala (a blend of three fruits) and Guggulu (a resin). It is prescribed in the postoperative management of Bhagandara to reduce inflammation, improve digestion, and promote healing. It is part of the oral medication regimen for patients undergoing the Window Technique.

18) Shalyatantra (Salyatantra, Shalya-tantra, Shalyatamtra):
Shalya-Tantra is the branch of Ayurveda that deals with surgery and surgical techniques. The document discusses the Shalya-Tantra approach to treating Bhagandara using a combination of minimal invasive surgery (Window Technique) and traditional Ayurvedic therapies like Kshara Sutra.

19) Katutikta (Katu-tikta):
Katu-Tikta refers to the pungent-bitter taste in Ayurvedic medicine. Medicinal preparations with Katu-Tikta Rasa, such as Jatyadi Taila used in Bhagandara treatment, possess properties that help in wound drying, cleansing, and promoting healing.

20) Discussion:
The discussion section of the document elaborates on the effectiveness of using the minimal invasive Window Technique for treating Bhagandara. It explains the method's advantages, such as minimal postoperative pain, reduced healing time, and lower recurrence rates, compared to conventional treatments.

21) Painting:
In the procedural context, painting refers to the preparation of the surgical site with an antiseptic solution like Betadine before the operation. This step is crucial to ensure a sterile environment, thereby reducing the risks of post-operative infections during the treatment of Bhagandara.

22) Allergy:
The document mentions that the patient had no known drug allergy, which is an essential consideration prior to any surgical procedure to prevent allergic reactions that could complicate the treatment and recovery process.

23) Tantra (Tamtra, Tantrism):
Tantra in Ayurveda signifies a branch or system of medicine. Shalya Tantra refers to the surgical branch, focusing on operative procedures. The document showcases the use of Shalya Tantra techniques in treating Bhagandara, integrating Ayurveda's surgical principles with modern minimal invasive methods.

24) Ropana:
Ropana in Ayurveda means healing or curative action. Jatyadi Taila, used in post-operative care for Bhagandara, has Ropana properties that aid in the healing of wounds, reducing inflammation, and drying up secretions, thus promoting faster and better recovery.

25) Jaipur:
Jaipur is the location where the study was conducted, specifically at the National Institute of Ayurveda (NIA). The authors, including Lokendra Pahadiya, who are affiliated with NIA in Jaipur, researched and implemented the minimal invasive Window Technique for treating complicated cases of Bhagandara.

26) Family:
The document notes that there was no family history of Bhagandara in the patient's case, which is relevant for understanding potential genetic or hereditary risk factors in the occurrence and recurrence of the disease.

27) Dosha (Dosa):
Dosha refers to the three fundamental bodily bio-elements in Ayurveda: Vata, Pitta, and Kapha. The condition Sambukavarta Bhagandara is described as a Tridoshaj (involving all three doshas) and is thus considered particularly difficult to treat due to the complex interplay of these bio-elements.

28) Tikta:
Tikta is the bitter taste in Ayurvedic medicine. Medicinal preparations with Tikta Rasa, such as Jatyadi Taila, are used in postoperative treatment for Bhagandara to help dry secretions, cleanse the wound, and promote healing.

29) Basti:
Basti refers to an area in the body, particularly the pelvic region. In the context of Bhagandara, the disease affects the Basti area, including the perianal and anorectal regions, which are crucial in understanding the disease's anatomical implications.

30) Linen:
Linen refers to the surgical linen sheets used for draping the patient during the operation. Proper draping is essential in maintaining a sterile field and minimizing infection risks during the surgical treatment of Bhagandara.

31) Ayus (Ayush):
AYUSH stands for Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy. The document is published in the AYUSHDHARA journal, reflecting the integration and application of these traditional systems of medicine, particularly Ayurveda, in modern clinical practices for treating conditions like Bhagandara.

32) Katu:
Katu is the term for pungent taste in Ayurveda. Oils like Jatyadi Taila, used in the management of Bhagandara, often have Katu Rasa, which aids in drying and cleansing wounds, thereby supporting the healing process.

33) Rasa (Rasha):
Rasa refers to the taste or essence of Ayurvedic medicines. In the treatment of Bhagandara, Jatyadi Taila with Katu-Tikta Rasa is used for its healing properties, helping to dry wound secretions and promote effective tissue repair.

34) Guda:
Guda in Ayurveda refers to the anal region. Bhagandara, as described in the text, specifically affects the Guda, with tears and fistulas occurring in and around this area, making its surgical and medicinal management crucial.

35) Guna:
Guna refers to qualities or properties of substances in Ayurveda. The Jatyadi Taila used postoperatively in Bhagandara treatment has Shodhan (cleansing) and Ropana (healing) Guna, which contribute to its effectiveness in promoting wound healing and reducing inflammation.

36) Drug:
The document mentions that the patient had no known drug allergies, which is critical information for safe medical and surgical intervention. This ensures that prescribed medications and anesthesia during the Bhagandara treatment do not cause adverse reactions.

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Discover the significance of concepts within the article: �Minimally Invasive Window Technique for Horseshoe Fistula: Case Report�. Further sources in the context of Science might help you critically compare this page with similair documents:

Ksharasutra, Fistula in ano, Ayurvedic medication, Postoperative management, Preoperative procedure, Hospital stay, Surgical Modalities, Cryptoglandular theory, Sambukavarta Bhagandara, Anal gland.

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