Background:  Though open fistulectomy surgery has been practised for centuries to treat cases  of  fistulae in ano, new methods of managing the same with Ksharasutra, an ayurvedic seton⁹ has been evolved in the recent times. But even this method has considerable per and post operative morbidity and poor patient satisfaction though the chances of recurrence are less. Hence still newer method is hereby discussed modifying the routine method of management with Ksharasutra with better patient acceptablility.

Material & Methods: A prospective study of patients with fistulae in ano attending the private surgical clinics and the OPD of the working hospital from January 2017 to dec 2018. Study design; prospective study. Study setting; the present study is done at the research centre of GIMSR with due institutional permission and clearance.

Results: Among 100 patients 52 were of modified procedure group and 48 were of routine procedure group of management of fistulae in ano with Ksharasutra, the caustic thread of ayurvedic chemical preparation. 86 % were males and 54 % were in the 4^th decade. 74 % fisulae are inter-sphincteric and 26 % were of trans-sphincteric variety. Relatively more severe post operative pain (7.7 % Vs 25 %) was reported in the routine group, and   wound discharge was more associated with the routine group again ( 8.3% Vs 15.3% ) wound scarring, bleeding, infection were also relatively more common in the routine group.  There is significant difference in the post operative pain which is least common in the modified group. Modified + Ksharasutra group takes less time to heal (mean 35.7 Vs 53 days, P = 0.002) and this group patients experience reduced disruption to their routine work and early return to the work front (2.7 Vs 15.5 days work off, P > 0.001). In both the groups of cases there is no open wound which was distressing in the open fistulaectomy patients in the past. Modified method is very cost effective and most patient acceptablility & satisfaction. In both the groups recurrence is least.

Conclusion: The modified procedure is most suitable for multiple non tuberculosis fistulae in ano. In both the methods, Ksharasutra is used during procedure. The modified method of managing the case of fistulae in ano with Ksharasutra is simple, one stage procedure, less morbidity, short hospital stay, least pain, cost effective, early return to work and better patient satisfaction & acceptance.

Keywords: Fistulae in ano, modified, Ksharasutra.

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Prof. Mohan Patro.P

Dept of Gen Surgery, GIMSR