Fistula-in-Ano: Treatment Options

Fistula-in-ano is a chronic abnormal communication between the anal canal and the perianal skin. Treatment aims to eliminate the infection and close the tract while preserving anal sphincter function.

1. 🔬 Medical Management (Initial Stage)

• Used in low-grade or early-diagnosed fistulas.

• Includes antibiotics, anti-inflammatory drugs, and sitz baths.

• Often supportive and used as preparation before definitive treatment.

2. 🪔 Ksharsutra Therapy (Ayurvedic)

• A time-tested Ayurvedic method using a medicated thread inserted into the fistula tract.

• The thread gradually cuts and heals the tract.

• Minimal invasion, effective for simple and complex fistulas.

• Requires weekly thread changes and follow-ups.

• Preserves sphincter and reduces recurrence.

3. 🔥 Laser Treatment (FiLaC – Fistula Laser Closure)

• A minimally invasive method where a radial laser fiber is inserted into the fistula tract.

• Laser energy ablates the tract from inside, promoting closure.

• Painless, bloodless, and with faster recovery.

• Ideal for straight, low trans-sphincteric fistulas.

4. 💉 LIFT Procedure (Ligation of Intersphincteric Fistula Tract)

• The fistula tract is accessed in the intersphincteric plane and ligated.

• Maintains sphincter integrity and reduces recurrence.

• Suitable for trans-sphincteric fistulas.

• Performed under spinal or general anesthesia.

5. 🔄 IFTAK Procedure (Interception of Fistulous Tract with Application of Ksharsutra)

• A modified Ayurvedic-modern hybrid technique.

• Involves interception of the internal opening, and minimal tract excision, followed by Ksharsutra application.

• Effective for complex and high fistulas.

• Less pain and faster healing.

6. 💧 Multidrain Technique

• Used in high or horseshoe fistulas with multiple tracts.

• Combines drainage, tract separation, and healing approaches.

• May include staged procedures or seton placement.

7. ✂️ Fistulectomy / Fistulotomy

• Fistulectomy involves complete surgical excision of the fistula tract.

• Fistulotomy involves laying open the fistula tract to heal by secondary intention.

• Effective but may risk sphincter damage in high-level tracts.

8. 🧵 Seton Placement

• A thread or medicated material is placed to keep the tract open and allow slow cutting or drainage.

• Used in complex or high-level fistulas involving sphincters.

9. 🧬 Advancement Flap Surgery

• The internal opening is closed using a mucosal flap.

• Used when the internal opening cannot be safely opened or removed.

• More complex but sphincter-saving.

✅ Choosing the Right Treatment

Treatment depends on:

• Type and complexity of the fistula

• Location of the tract (low or high)

• Previous surgeries or recurrence

• Patient preference and availability of expertise

At Bhardwaj Hospital, Varanasi, we offer comprehensive treatment options ranging from Ayurvedic Ksharsutra to advanced laser surgery, tailored for each patient by experienced surgical team. for more visit-

https://bhardwajhospitals.in/-fistula-in-ano-