DL- KAST ( A hybrid technique for Complex fistula in Ano)

By  Dr Vishnu S Kaalimadom BAMS, CCKS(NIA), Kaalimadom Ayurveda hospital- Thodupuzha & Irumpanam

What is Fistula in Ano?

   An  abnormal passway between the skin and the anus.

Symptoms

1. Swelling & pain around the anal region
2. Pus discharge with or without blood once abscess gets opened
3. Fever and chills ( not every time)
4. Itching around the anus

Diagnosis

1. Examination by a specialist
2. MRI fistulogram
3. TRUS
4. Fistulography

Types of Fistula

1. Intersphincteric
2. Trans sphincteric
3. Suprasphincteric
4. Extra sphincteric

Treatment Methods in modern medicine

1. Fistulectomy
2. Fistulotomy
3. Advanced Flap procedure
4. LIFT
5. VAFT
6. Laser surgery
7. Fibrin glue treatment
8. Bioprosthetic Plug

Complications in Fistula Treatment

1. Incontinence for stools
2. Incontinence for flatus
3. Anal stenosis
4. Recurrence
5. Lack of wound healing 

Complications, if Fistula not treated 

1. Formation of Abscess
2. Simple to Complex fistula, if not treated in time
3. Increased recurrence rate
4. More time to heal

How to treat a Complex fistula with DL-KAST method

   DL-KAST ( Distal Laser- followed by Kshara Application Internally and Seton Drainage)

Advantages

1. No admission required
2. Complex Fistula can be treated in 2 sittings, 14 days gap between each sittings
3. Cost effective
4. Minimal invasive
5. Less/ no pain
6. High success rate
7. Patient can perform their daily activities one or two days after the procedure
8. No chance of incontinence
9. Minimal scar formation
10. Fast recovery

How to perform DL- KAST

Whole procedure can be performed under Local Anesthesia

1. Probing done from External opening to internal opening or Viceversa
2. Window is made in the Inter sphincteric space  and dye is pushed from external opening to confirm the tract( dye should come out through the  window)
3. Once the tract is confirmed, we can probe from intersphincteric space to internal opening or reverse probing from internal opening
4. Internal opening is widened with cautery towards anal verge 
5. Kshara is applied in the internal opening for 100 matrakaala
6. Wash the kshara with normal saline and Nimbu swarasa
7. After proper cleaning, Seton/ ksharasutra is placed from the internal opening to the inter sphincteric space for drainage ( Note: Thread should not be tight)
8. Laser ablation is performed from the external opening up to the newly created window with Radial fiber  10w 1470nm diode laser  for 1 sec:1 cm ratio.
9. Second sitting after 14 days. During second sitting, lay open the remaining tract from the anal verge to intersphincteric space and apply kshara .

Advice during treatment

1. Vasti with yashtimadhu tailam 10 ml at night
2. Avagaha sweda with Triphala-yashtimadhu  kwatha
3. Ropana ointments
4. Internal medicines: Tab Triphala guggulu, Tab Gandhaka rasayanam BID for 28 days.