IFTAK (Interception of Fistulous Tract with Application of Ksharasutra) Technique: A Novel Approach in the Management Anal Fistula

Abstract

Fistula in ano is a chronic suppurative condition of anorectal origin that frequently develops from cryptoglandular infection and is associated with persistent symptoms, recurrence, and the potential risk of sphincter damage. Although Kshara Sutra (medicated seton) therapy is a well-established Ayurvedic surgical procedure for its management, conventional practice is often limited by prolonged treatment duration, pain, and reduced patient compliance. The Interception of Fistulous Tract with Application of Kshara Sutra (IFTAK) technique has been developed to overcome these limitations by targeting the primary site of infection. A 51-year-old male patient presented with a two-and-a-half-year history of recurrent pus discharge from the perianal region accompanied by mild pain, itching, and difficulty in sitting. Clinical examination revealed a hypertrophied external opening at 2 o’clock position and an internal opening at the 6 o’clock position at the dentate line, with normal anal sphincter tone based on clinical assessment, a diagnosis of fistula-in-ano (Bhagandara) was made. The patient was treated using the IFTAK technique under local anesthesia. Weekly Kshara Sutra changing was performed, and curettage of the tract was undertaken when indicated. Progressive improvement was noted with a marked reduction in pain and purulent discharge. Complete resolution of discharge was achieved, followed by successful cut-through and full wound healing with minimal scarring. Anal continence was preserved, and no complications were observed. The patient remained symptom-free, with no recurrence during a one-year follow-up period. This case demonstrates that the IFTAK technique is an effective and safe modification of conventional Kshara (medicated seton) Sutra therapy for fistula in ano. By addressing the primary cryptoglandular source and reducing the length of the treated tract, IFTAK offers faster healing, improved patient comfort, and favorable clinical outcomes without recurrence.