Abstract
Objective Despite all the technological advances, successful management of complex fistula-in-ano
is still a challenge due to recurrence and incontinence. The present study evaluates
the outcomes of a novel technique, Interception of Fistula Track with Application
of Ksharasutra (IFTAK) in terms of success rate and degree of incontinence.
Methods In the present prospective study, 300 patients with complex fistula-in-ano were treated
by the IFTAK technique, whose surgical steps include: incision at the anterior or
posterior midline perianal area, identification and interception of the fistulous
track at the level of the external sphincter, rerouting the track (and extensions)
at the site of interception, and application of a ksharasutra (medicated seton) in
the proximal track (from the site of interception to the internal opening) that is
laid open gradually, with the resulting wound healing with minimum scarring. The distal
track is allowed to heal spontaneously.
Results There were 227 trans-sphincteric and 73 intersphincteric varieties of fistula with
supralevator extension in 23 cases, of which 130 were recurrent fistulas, 29 had horseshoe
track, while 25 had blind fistula with no cutaneous opening. The mean duration of
the ksharasutra application was 8.11 ± 3.86 weeks with an overall success rate of
93.33% at the 1-year follow-up. A total of 3.67% of the cases reported with a mild
impairment of continence on the Wexner incontinence scoring system. Pre- and postoperative
anal manometry evaluation showed minimal reduction in median basal and squeeze pressures.
Conclusion The IFTAK technique is a minimally invasive, daycare surgical procedure for the management
of complex fistula-in-ano with low recurrence and minimal sphincter damage.
Keywords
complex fistula-in-ano - ksharasutra - IFTAK - recurrence - incontinence
