Kshar Sutra and Fistula in Ano

CONTENTS
1. Anatomy and Physiology of the Rectum and Anus:
-The rectum, Blood supply, Venous return. Lymphatics. Nerve supply. The fascia of the rectum.
-The Perineum
The Anal canal, The linings, of the anal canal. The Anal Columns, The anal pit part. The aretrial supply, Veins, Lymphatics, Nerves.
- The Anal sphincters, External sphincter, superficial part, Middle part, Deep part. Internal sphincter, Corrugator cut is Ani muscle, fascia of the anal region, The perineal fascia.
The Ischiorectal fossa, Ano-coccygeal body. Perineal space. The perineal body.
2. Investigation of a rectal case:
- History taking. The postion for examination of the patient. Equipment, Digital examination, Goodsall's rule, Examination for associated condition,s Visual examination, Proctoscopy, Sigmoidoscopy, Investigations.
3. Bhagandara Pidika (Cryptitis):
- Fistula in ano, Cryptitis.
4. Gud-Vidradhi (Ano-rectal abscess):
- Peri-anal, Peri-rectal, Ischio-rectal, Submucous,
Pelvi-rectal abscess.
5. Bhagandara (Fistula in Ano):
- Ayurvedic concept of Bhagandara, Nadi-Vrana, Aetiology, and predisposing factors, Classification, Vagbhatta's view, Diagnosis, Prodromal symptoms,
-Modern concept and classification. Special types of Fistula encountered in practice.
6. Treatment:
Management of Bhagandara, General principals of treatment, and Preventive measures.
7. Kshar Sutra Treatment:
-Preparation of Kshar Sutra, Ingredients. Processing of Kshar Sutra, smearing, drying and sterilization Packning. Storage.
- Selection of patients, Limitations of treatment.
- Instruments and equipment required,
- Method of aplication of Kshar Sutra, change of Kshar Sutra, Feequency of change of Kshar Sutra, Rate of cutting, Unit cutting time.
- Probable mechanism of action of Kshar Sutra.
- Benefits,
8. Surgery for complex anal Fistula
- By Dr. Ashok Kumar