Modified IFTAK Technique in the Management of Complex Subscrotal Fistula in Ano

Abstract

Fistula in ano is one of the most common and challenging anorectal disorders due to its recurrent nature and risk of sphincter damage. The clinical presentation of fistula in ano closely resembles Bhagandara described in Ayurvedic classics. Among the various treatment modalities mentioned in Ayurveda, Ksharasutra therapy has shown promising results; however, prolonged treatment duration, postoperative pain and scarring remain its major drawbacks. Modified IFTAK (Interception of Fistulous Tract with Application of Ksharasutra) has recently emerged as a minimally invasive sphincter-saving procedure aimed at overcoming these limitations. A 62-year-old male patient presented with complaints of recurrent boil, swelling, pain and purulent discharge from the subscrotal region in the last one year. The patient was a known case of Type 2 Diabetes and hypertension. Clinical examination revealed an external opening at the base of the scrotum with internal opening at 12 o’clock position. MRI fistulogram demonstrated a 10cm long anterior transsphincteric fistulous tract extending towards the subscrotal region. The patient was managed with Modified IFTAK using Apamarga Ksharasutra along with partial fistulectomy and curettage of the tract. Postoperatively, pain reduced within 2–3 days and purulent discharge subsided within 10–15 days. Complete wound healing was achieved within 5 weeks with preservation of continence and no recurrence during 8 weeks follow-up. The present case highlights Modified IFTAK as an effective sphincter-saving approach for complex fistula in ano with reduced morbidity and faster recovery.