Friday, November 18, 2016

Pilonidal Sinus can be treated with out surgery

Pilonidal sinus presents itself as a nodular swelling in lower spinal region. Occasional pus discharge is also observed. When pus is discharged from the sinus patient feels better. 

Reason for Pilonidal Sinus: Usually pilonidal sinus is a disease of hairy skin. It is a normal phenomenon that hair keep on shedding off. These shedded hair prick in the skin in lower spinal area (specially between the buttocks; because of movement there is more shedding of hairs in this area and due to moisture and other local reasons these hair prick in the skin making a way for infection to travel inside).

This inward growth of infection makes a tunnel like structure named as Pilonidal Sinus. In starting anti biotics are tried to treat this condition and  no doubt these show results in starting and patients feels that he is okay. 

As the tunnel in patent under the skin; again infection will be there and similar conditions appear. As long as this sinus tract will be there; there will be recurrence of infection and with every infection the sinus tract will be increasing in size. So exact treatment for this condition will be to destroy the sinus tract. In modern medicine this tract is destroyed with surgical intervention. But in surgery there are always chances of recurrence (Pilonidal sinus is not simply infection but there are also certain local changes in the nearby area; surgery will destroy only the affected area; without affecting nearby area)

Whereas in Ayurveda; Pilonidal Sinus is treated with Ksharsutra treatment. This treatment involves ligation of sinus tract with medicated thread. Medicine applied on the thread keeps on releasing in the sinus tract. This medicine known as Kshar cleans the tract of any infection; brings healthy changes in nearby tissue and at the same time cuts the sinus tract. Healing of the tract takes place simultaneously with cutting of tract.

Ksharsutra ligation of sinus tract is done under local anesthesia so there is no complication in Ksharsutra treatment which are generally associated with general or spinal anesthesia. 

Ksharsutra ligation of sinus tract is done as a OPD procedure and patient can join his working on very same day of Ksharsutra ligation. Medicine coated on Ksharsutra works for 7 to 10 days. So after every 7 to 10 days this thread needs to replaced with the fresh thread. 

In Ksharsutra treatment only the tract is followed so there is no risk of heavy bleeding or loss of healthy tissue. This makes Ksharsutra treatment a traetment of choice for Pilonidal sinus. To check the progress of treatment lop length of Ksharsutra is measured. It is observed that with every thread change; length of thread decrease by about 0.5 to 1 cm. In this pattern final cut through is achieved with the help of medicated thread only and there is no need surgical intervention. 

In our more than 20 years experience of treating Pilonidal Sinus patients we did not observe any recurrence till date. With development of Graded Ksharsutra; Ksharsutra treatment has become more convenient for the patients. You can check more details about Ksharsutra treatment for Pilonidal Sinus at following link

Tuesday, November 15, 2016

Anal Fistula Now Can Be treated Without Surgery

Anal fistula a challenge for modern surgery but curable by  grade Ksharsutra in Ayurveda (Indian system of medicine).

Anal fistula is a disease for which different methods of treatment have been advocated time to time, Even today when we are talking about robotic surgery, this disease has no satisfactory method of treatment in modern surgery. The latest method of video assisted anal fistula treatment (VAAFT) is not satisfactory due to high incidences of recurrence after the surgery.
But we at Sushruta Anorectal Institute new Delhi are successfully treating all these complex anal fistulae without surgery  & with the help of graded Ksharsutra (healing thread for fistula-in-ano) developed from Ayurveda.

In Ayurveda about 2000 yrs ago Acharya Sushruta has indicated Ksharsutra treatment to treat fistula-in-ano. Late professor P J Deshpandeyat faculty of Ayurveda Institute of Medical Sciences B H U, had done extensive research in this field and established a treatment module to treat this disease.In 1990 Indian council of medical research has clinically evaluated this Ayurvedic treatment module at four premiere institutes in our country including AIIMS Delhi & P G I Chandigarh . Subsequently it was concluded by I.C.M.R.that in the patients of fistula in ano, Ksharsutra treatment is more effective& convenient as compared to modern surgery.

Ksharsutra is a thread coated with certain Ayurvedic medicines known for their antiseptic, debridement & healing properties. After u v sterilization this medicated thread (Ksharsutra) is used under entirely aseptic precautions in the patients. The patient is routinely investigated with special reference to any other associated disorder like hypertension, diabetes mellitus, tuberculosis etc. The next step lies In the proper identification& evaluation of the fistulous tract. It is mandatory to define the fistula tract wrt its depth, direction & branching pattern. This may be achieved by careful probing under expert hands using malleable probes& if required help may be taken from other investigations like x ray, fistulogram or MRI fistulogram. Once the tract has been clearly defined the Ksharsutra is placed in it with the help of certain instruments, under local anesthesia.This entire procedure usually takes ten to fifteen mins. As there is no cutting of tissues hence no bleeding, no pain & patients can go home after half an hr rest in the day care room. The medicine coated on the thread is gradually released in the tract.

The cumulative effect of the coated drugs exerts a powerful debridement effect on the fistula tract & induces healing by the fresh & healthy granulation tissues. Thus Ksharsutra is the mechanism of drug delivery precisely at the tissues involved. Every seventh or tenth day the old sutra is replaced with a new Kshsrsutra till there is a finale cut through. It has been observed that the tract heals @ 0.5-1 cm per week. The postoperative complications like recurrence of the disease, fecal incontinence, bleeding is not seen with Ksharasutra treatment. Further this therapy is performed as an OPD procedure. No general anesthesia & no hospitalization is required. Patient maintains his normal routine activities as usual during treatment period.  

At Sushruta Anorectal Institute we have been working on this disease including piles fissures & pilonidal sinus for the last 15 yrs. Here we have developed the concept of graded Ksharsutra which has given us a more effective & convenient way to treat anal fistula. on record At Sushruta Anorectal Institute we have treated thousands of patients of anal fistula from different states including overseas patients. We have records to prove that the patients of high anal complex fistula, those have been operated two or three times but failed to heal were successfully treated at this institute.