An integrative approach with TROPIS, Tube in Tract and IFTAK therapy in the management of Complex Anal Fistula: An experience

The management of complex anal fistulae is a challenging job because of the possible risk of damage to the anal sphincter leading to fecal continence, high reoccurrence rate, and delayed wound healing. Other challenges include proper drainage of the tract without disturbing anatomical alignment and painless defecation. This case presented to the outpatient department with a history of recurrent boil in the perianal region and painful pus discharge from the site for 15 days. The case was diagnosed as a case of complex fistula-in-ano and was managed by an integrative approach operative procedure under spinal saddle block anesthesia. Principles of application of Interception of Fistulous Tract and Application of Ksharasutra (IFTAK), transanal opening of intersphincteric space, and tube in tract technique were applied in the management. With necessary analgesia and antibiotics for five days, the patient was given Triphala guggulu internally, and sitz bath with Haritaki (Terminalia chebula Retz.) and Neem (Azadirachta indica A. Juss.) decoction, postoperatively. Wound dressing was done by application of a gauze piece soaked in Apamarga kshara taila. The management resulted in a painless recovery and the patient started attending his daily routine activities from the 7^th post-operative day onwards. Pus discharge ceased soon after the operative procedure. Complete healing of postoperative wounds was achieved in ten weeks with prescribed postoperative care and regimen. For the last year, the patient is free from anal discomfort and no reoccurrence has been reported till now.