Anal Fistula & Ksharsutra Treatment
An anal fistula is an abnormal tunnel connecting an infected gland inside the anal canal to the skin around the anus. Treated by Dr. Vipin Tongale with classical Ayurvedic Ksharsutra and FiLaC laser, with over 16,000 surgical procedures performed.
An anal fistula (Bhagandara) develops following an untreated perianal abscess. Because the tract passes through the anal sphincter muscles, conventional surgical cutting (fistulectomy) risks fecal incontinence. At Shri Manmukund Hospital, we specialize in classical Ksharsutra para surgery and FiLaC (Fistula Laser Closure). The medicated Ksharsutra thread cuts and heals the tract simultaneously from the inside out, preserving sphincter integrity with less than 2% recurrence rate.
Recognizing an anal fistula.
Fistulas typically manifest as recurring boils that burst, discharge pus or blood, and refill.
Pus & fluid discharge
Continuous or intermittent pus, watery fluid, or blood staining undergarments.
Recurrent painful swelling
A tender lump near the anus that swells painfully until it discharges and temporarily relieves pressure.
Fever and chills
Systemic signs when the external opening closes and pus accumulates under pressure.
Perianal skin irritation
Redness, itching, and excoriation of skin caused by chronic exposure to discharge.
Pain with sitting & walking
Deep, throbbing discomfort in the gluteal and perineal area that intensifies with movement.
Foul odor from perineum
Offensive smell due to chronic bacterial colonization of the anorectal tract.
An untreated fistula will continue to branch, creating horseshoe tracts, high suprasphincteric extensions, and multiple external openings that become significantly harder to treat. Early Ksharsutra ligation resolves simple tracts in weeks.
Fistulas are staged by anatomical depth.
The relationship of the fistula tract to the external sphincter muscle determines the safest surgical technique.
Intersphincteric
Tract lies between internal and external sphincter layers. Most common and straightforward to treat.
Transsphincteric
Tract passes through both sphincter muscles. Traditional surgery risks incontinence; Ksharsutra is gold standard.
Suprasphincteric
Tract curves above the puborectalis muscle before exiting downwards. Requires expert sequential threading.
Horseshoe / Recurrent
Tract wraps around both sides of the rectum with multiple openings. Patients previously operated elsewhere.
Why anal fistula develops.
Infected anal cryptoglandular crypts form the originating focus.
Over 90% of anal fistulas originate from infection of the small crypt glands located at the dentate line inside the anal canal. When a gland duct becomes blocked by stool or debris, an abscess forms in the intersphincteric space.
When the abscess bursts or is drained externally, a chronic epithelialized tunnel remains connecting the internal source to the skin.
- Prior perianal abscess. Up to 50% of acute perianal abscesses leave behind a permanent fistula tract.
- Cryptoglandular bacterial infection. Stagnant secretions in anal glands become colonized by fecal bacteria.
- Failed previous fistula surgeries. Incomplete excision or missed secondary branches cause persistent recurrence.
- Crohn’s disease & colitis. Inflammatory bowel disorders causing transmural intestinal ulceration.
Precise tract mapping for near-zero recurrence.
We identify every primary opening, secondary branch, and cavity before beginning treatment.
Clinical Probing with Goodsall’s Rule
Careful anatomical evaluation to predict internal opening location.
High-Definition Anoscopy
Visualizing the internal crypt opening with magnification.
Pelvic MRI Fistulogram
For complex, recurrent, or high fistulas to map occult horseshoe extensions.
Ksharsutra Sizing & Planning
Selecting the appropriate medicated linen thread thickness and chemical potency.
Specialised interventions for anal fistula.
Dr. Vipin Tongale has over 15 years of experience resolving thousands of complex and recurrent fistulas.
Classical Ksharsutra Para Surgery
Best suited for: All grades of simple, complex, and recurrent fistulas
A specially prepared linen thread coated 21 times with Snuhi Ksheera, Apamarga Kshara, and Haridra powder. Cuts the infected tract mechanically and chemically while laying down healthy fibrous tissue behind it, preserving sphincter continence.
FiLaC (Fistula-tract Laser Closure)
Best suited for: Straight, uncomplicated low-to-mid transsphincteric tracts
A 360° radial emitting laser fiber is introduced along the fistula tract. Emitted laser energy seals and ablates the epithelial lining from inside without creating external wounds.
IFTAK (Interception of Fistulous Tract & Ksharsutra)
Best suited for: High transsphincteric and suprasphincteric fistulas
Combines modern tissue dissection of the lateral tract with Ksharsutra ligation only across the sphincter-traversing segment, significantly shortening overall healing time.
What to expect during Ksharsutra therapy.
A structured, step-by-step healing process where patients continue normal daily work.
Initial Ksharsutra insertion
Minor procedure under local or spinal anaesthesia. Medicated thread is gently routed through the tract.
Sequential thread replacement
5-minute weekly visit to replace thread. The old thread guides the new one through with minimal discomfort.
Gradual tract excision & healing
The thread cuts through the tract millimetre by millimetre while healthy granulation tissue seals the base.
Permanent closure confirmed
Thread comes off naturally once tract is healed. Scar is strong, clean, and sphincter is intact.
Common questions, honestly answered.
Why is Ksharsutra better than open surgery for fistula?
Open surgery (fistulectomy) cuts through the anal sphincter muscle in one go, carrying a high risk of stool leakage or fecal incontinence, and has a 20-30% recurrence rate. Ksharsutra cuts through the muscle gradually (1 mm per week), allowing the divided muscle to scar down and fuse before the next fiber is cut. This safeguards sphincter continence and brings recurrence down to under 2%.
Can I go to office and do routine activities during Ksharsutra?
Yes, absolutely. Ksharsutra is an ambulatory treatment. Most patients return to their desk job or business within 24 to 48 hours after thread placement and continue work normally throughout the weekly changes.
What happens if a fistula is left untreated?
Fistulas do not heal with oral antibiotics or ointments. Untreated fistulas lead to recurrent painful abscesses, additional branching tracts (horseshoe fistulas), complex high extensions, and permanent damage to sphincter muscles.
Ready for an honest opinion on your case?
Book a consultation. We will examine, grade, explain, and give you an honest recommendation. If we think you should be seen by a different type of specialist, we will say so.