(a) Left trans-sphincteric fistula (curved track shown by white dotted lines) extending from the 1 o’clock position of the external opening (white arrow) to the posterior midline at the 6 o’clock position of the internal opening;
(b) 3D-TRUS image showing the course of the track (yellow arrows) from the 1 o’clock position, traversing along the external sphincter on the left lateral side and piercing through the sphincters at the posterior midline to open into the anal canal at the 6 o’clock position;
(c) Linear vertical incision taken in the posterior midline with interception of fistulous track (white arrow);
(d) Jet of fluid coming out from the external opening on injecting the fluid through the site of interception (window) showing the free communication of the track with the window;
(e) Probe passed in the proximal track through the site of interception (window) with ksharasutra mounted at the tip of the probe;
(f) Ksharsutra applied in the proximal track;
(g) Healed external opening (yellow dotted circle) with healthy granulating wound after 1 week with ksharasutra in situ; and
(h) Completely healed fistula (yellow dotted circle) after 3 weeks of IFTAK treatment with minimal scarring in the posterior midline.
