Minimally Invasive Technique for the Management of Ano-Scrotal Fistula

Abstract

Anal fistula with scrotal extension is a complex presentation of fistula-in-ano arising from cryptoglandular infection. Its anterior location and proximity to delicate structures make management challenging. Conventional Ksharasutra therapy is effective but may be associated with prolonged treatment duration, postoperative discomfort, and scarring. So minimally invasive method has been proposed as a modified sphincter-preserving technique to address these limitations. A 45-year-old male patient presenting with recurrent perianal and scrotal discharge was clinically examined and diagnosed with anterior low trans-sphincteric fistula having scrotal extension with a common internal opening at 12 o’clock position. Minimally invasive technique was performed by intercepting the fistulous tract 2cm from the anal verge, followed by Ksharasutra ligation of proximal and distal segments. Adjunctive management included Murivenna instillation, irrigation with copper sulphate solution, internal Ayurvedic medications such as Gugguluthiktaka Kashaya, Guggulu Panchapala Choornam, Kaisora Guggulu, Triphala Choornam, and regular sitz bath. Pain and purulent discharge significantly reduced within two weeks, and complete tract cut-through occurred by the third week. Total wound healing was achieved within five weeks. No recurrence was observed during one-year follow-up. Minimally invasive and sphincter- preserving technique appears to be a safe approach for fistula-in-ano with scrotal extension. It reduces treatment duration, tissue trauma, postoperative morbidity, and scarring while effectively addressing the cryptoglandular source. Larger prospective studies are required to establish standardized protocols and long-term outcomes.