What is Advance Ksharsutra Technique (Iftak) and Why it is Better Than Classical Ksharsutra Technique in Fistula in Ano Treatment?

Advance ksharsutra (IFTAK) is modified technique of classical ksharsutra to reduce recovery time. Advance ksharsutra or IFTAK (interception of fistulous tract and application of ksharsutra) technique, as name indicates in this we do interception of the fistula tract at intersphincteric groove. To understand it in a better way I am going to demonstrate it with an example of a patient.

Case history: – 50 years male presented with complaint of pus discharge from a boil in perineal region since 2 years on and off. H/O fistula in ano 12 years back operated elsewhere. Patient is a K/C/O Diabetes and Hypertension.

On examination external opening of fistula treatment at 1 o’clock position and on P/R examination there is internal opening at 6 o’clock position approximately 3 cm inside the anal verge.

In this case we have planned to do advance ksharsutra. We have done interception of fistula tract at intersphincteric groove at 6 o’clock position. Artificial opening was made at 6 o’clock position externally and ksharsutra ligation done by passing from this opening to pass through internal opening. And drain was kept at 1 o’clock position opening for some time for drainage purpose. In this way we reduce the length of tract to 3 cm approximately; actual length of tract is approximately 9 cm.