A Sphincter-Saving, Effective Alternative to Major Surgery

Fistula-in-ano is a challenging anorectal disease, and its management becomes even more difficult when the fistula is complex in nature. Complex fistulas often present with multiple ramifications, branching tracts, and associated cavities, making conventional surgical procedures risky and prone to complications such as recurrence, incontinence, and extensive scarring.

The Multidrain Technique is an innovative and logical approach designed specifically for the management of complex fistula-in-ano, focusing on treating the root cause while simultaneously addressing all associated extensions—without damaging the anal sphincter.

Understanding Complex Fistula-in-Ano

Some fistulas are not simple linear tracts. Instead, they may have:

• Multiple branching tracts (ramifications)

• Secondary openings

• Deep or superficial cavities

• Horseshoe extensions

• Recurrent infections

Such fistulas are classified as complex fistulas and are often unsuitable for single-stage surgical procedures like fistulectomy.

Principle Behind the Multidrain Technique

The Multigrain Technique is based on a dual-system treatment approach, addressing both:

1. The root cause of fistula, and

2. The associated extensions, cavities, and secondary tracts

This targeted strategy ensures effective healing with minimal tissue damage.

Root Cause of Fistula

All cryptoglandular fistulas originate from infection of the anal glands, which are located in the intersphincteric plane. This infected gland gives rise to:

• Abscess formation

• Primary fistulous tract

• Secondary extensions and cavities

👉 Treating only the external or secondary tracts without addressing the root cause often leads to recurrence.

How the Multidrain Technique Works

🔹 Step 1: Identification of the Root Cause

A detailed clinical examination and imaging (if required) are performed to:

• Identify the infected anal gland

• Locate the intersphincteric component

• Map all fistulous extensions and cavities

🔹 Step 2: Treating the Root Cause with Ksharsutra

• The tract from the intersphincteric region to the internal opening is treated with Ksharsutra

• Ksharsutra gradually cuts and heals the tract simultaneously

• This ensures complete eradication of the primary source of infection

🔹 Step 3: Managing Extensions & Cavities with Drainage Systems

The remaining tracts, branches, and cavities are treated using different drainage systems, chosen according to the anatomical location and nature of the disease:

✔ Plain thread drain
✔ Rubber drain
✔ Corrugated drain
✔ Proline mesh drain

👉 The type of drain is decided individually, based on whether the tract is superficial, deep, wide, narrow, or cavity-based.

These drains:

• Maintain continuous drainage

• Prevent abscess formation

• Allow gradual healing of secondary tracts

Why It Is Called the “Multidrain” Technique

Just as multiple drains work together to provide complete nutrition, the Multidrain Technique uses multiple treatment modalities simultaneously:

• Ksharsutra to treat the root cause

• Selective drainage systems to treat multiple extensions

This combined approach ensures comprehensive disease control.

Advantages of the Multidrain Technique

✅ Sphincter-Saving Procedure

The technique avoids cutting through sphincter muscles, significantly reducing the risk of:

• Incontinence

• Weakness of anal control

✅ Avoids Major Surgery

Patients can avoid extensive procedures such as:

• Fistulectomy

• Fistulectomy with primary sphincter repair

✅ Minimal Scarring

As there is no wide excision of tissue, post-operative scarring is very minimal.

✅ High Patient Comfort

• Ambulatory or short-stay treatment

• Less pain and faster recovery

• Better acceptance by patients

✅ High Success Rate

The Multidrain Technique has shown a success rate of more than 90%, even in complex and recurrent fistulas.

Clinical Experience at Bhardwaj Hospital

At Bhardwaj Hospital, this technique has been successfully applied in more than 400 cases of complex fistula-in-ano, with:

• Cure rate exceeding 90%

• Negligible recurrence (around 5%)

• Excellent preservation of sphincter function

This consistent clinical success highlights the reliability and effectiveness of the Multigrain Technique.

Conclusion

The Multidrain Technique represents a safe, logical, and patient-centric advancement in the management of complex fistula-in-ano. By treating the root cause with Ksharsutra and managing the associated extensions with customized drainage systems, this technique offers:

✔ Effective healing
✔ Preservation of sphincter integrity
✔ Minimal scarring
✔ High success with low recurrence

For patients suffering from complex fistula-in-ano, the Multidrain Technique provides a powerful alternative to major surgical procedures—restoring health while maintaining quality of life.

Multidrain Technique for Complex Fistula-in-Ano – FAQs

Q1. What is a complex fistula-in-ano?

A complex fistula-in-ano is a type of anal fistula that has:

• Multiple branching tracts (ramifications)

• Secondary openings

• Associated cavities or abscesses

• Recurrent disease or deep extensions

Such fistulas are difficult to treat with conventional surgery and have a higher risk of recurrence and sphincter damage.

Q2. What is the Multidrain Technique?

The Multidrain Technique is an advanced, sphincter-saving method for treating complex fistula-in-ano.
It works by treating the root cause of the fistula and its multiple extensions simultaneously, using a combination of Ksharsutra and selective drainage systems.

Q3. Why is it called the “Multidrain” Technique?

Just like multiple grains together provide complete nutrition, this technique uses multiple treatment methods together:

• One system to treat the root cause of the fistula

• Another system to treat associated tracts and cavities

This combined approach ensures better healing and long-term success.

Q4. What is the root cause of fistula-in-ano?

Most fistulas originate from infection of the anal glands, which are located in the intersphincteric plane.
If this root cause is not treated properly, the fistula can recur even after surgery.

Q5. How does the Multigrain Technique treat the root cause?

• The tract from the intersphincteric area to the internal opening is treated using Ksharsutra

• Ksharsutra gradually cuts, drains, and heals the tract at the same time

• This ensures complete eradication of the infected anal gland

Q6. How are the multiple tracts and cavities treated?

The remaining fistulous tracts and cavities are treated using appropriate drainage systems, such as:

• Plain thread drain

• Rubber drain

• Corrugated drain

• Proline mesh drain

The type of drain is selected based on:

• Location of the tract

• Size and depth of the cavity

• Nature of infection

Q7. Does this technique involve cutting the anal sphincter?

No.
The Multigrain Technique is a sphincter-saving procedure. It avoids cutting the sphincter muscles, thereby minimizing the risk of:

• Incontinence

• Weak anal control

Q8. Is this treatment better than fistulectomy or major surgery?

Yes, especially for complex fistulas.
The Multigrain Technique helps patients avoid major surgeries such as:

• Fistulectomy

• Fistulectomy with primary sphincter repair

It provides effective healing with less pain, less scarring, and fewer complications.

Q9. What are the main advantages of the Multidrain Technique?

• Treats both root cause and extensions

• Preserves sphincter function

• Minimal post-operative scarring

• Better patient comfort

• Faster recovery

• High success rate (>90%)

Q10. What is the success rate of the Multidrain Technique?

The Multigrain Technique has a success rate of more than 90% in complex fistula-in-ano cases when performed correctly.

Q11. What is the recurrence rate with this technique?

At Bhardwaj Hospital, recurrence has been observed in only about 5% of cases, which is significantly lower compared to conventional surgical methods.

Q12. How many cases have been treated with this technique at Bhardwaj Hospital?

At Bhardwaj Hospital, more than 400 patients with complex fistula-in-ano have been successfully treated using the Multigrain Technique.

Q13. Is this treatment painful?

Pain is generally less compared to major surgical procedures.
Most patients remain comfortable and can continue daily activities with minimal discomfort.

Q14. Will there be a large scar after treatment?

No.
Since wide excision of tissue is avoided, post-operative scarring is very minimal.

Q15. Who is an ideal candidate for the Multidrain Technique?

This technique is especially suitable for patients with:

• Complex fistula-in-ano

• Multiple tracts or cavities

• Recurrent fistula

• Patients who want to avoid major surgery and sphincter damage

Conclusion

The Multidrain Technique is a safe, effective, and patient-friendly solution for complex fistula-in-ano. By addressing the root cause with Ksharsutra and managing multiple extensions with tailored drainage systems, it offers high success with minimal complications and excellent long-term results.