대한대장항문학회

Purpose: Sushrutra (BC 5th century) advocated a conservative management by applying<br>Kshara Sutra (phyto- chemically processed thread) for the treatment of anal fistulas in<br>India. In 1965, this technique was introduced by Deshpande and 40 cases were treated on an<br>'outpatient' ambulatory basis. The purpose of this study is to determine the result of<br>Kshara Sutra (KS) in treatment of fistula in ano.<br>Methods: One hundred and five patients with anal fistula were treated with KS. Excision<br>of the primary lesion and fistula tract was done externally and KS was passed around the<br>tract. Tissue gripped within the thread was the anoderm, mucosa, and sphincter. Finally,<br>the thread encircled the part of the anal wall that needed excision and an additional clamp<br>for loose tying.<br>Results: The range of age was from 21 to 59 years while the sex ratio was 6.5：1 (M：<br>F). In 94 patients, the average cutting time was about two weeks, and the other were three<br>to four weeks. KS thread was applied only once for primary operation in 98 cases, and a<br>successive change was required in 7 cases. The mean hospital stay after operation was 4.2<br>days. In 76 cases, the mean period of follow up was 23 (range 7∼32) months. There were<br>no recurrences, but there were 4 mild deformities of the anus, 2 mild soilings, 1 delayed<br>cutting, and 5 delayed healings.<br>Conclusions: Kshara Sutra is a technically easy, safe, and simple method and does not<br>require a long hospitalization.<br>