Kshar sutra ppt by Prof.Dr.R.R..deshpande

Kshar sutra ppt

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3/18/2015 1Prof.Dr.R.R.Deshpande

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Special Thanks for

His Knowledge & Guidance & References

• Dr.B.N.Deshpande,Professor & HOD

,Dept of Surgery ,CARC,Nigdi ,Pune 44

• BAMS & AVP (Surgery)

• Dr.B.N.Deshpande had performed N

number of Ksharsutra Procedures in

Ayurved Hospital ,Nigdi,Pune


God of Health = God Dhanvantari


Anatomy of Ano rectal region


Fistula in Ano ( Bhagandar)

• Bhagandara = Bhag + Daran

• Bhaga = Yoni ( Bhavamishra)

• Bhaga = Peri anal region

• Daran = Tare of surface


3 Stages of Fistula in Ano

• 1) Formation of Papule

• 2) Suppuration ( Abscess formation)

• 3) Burst open of suppuration


What is Fistula ?

• Abnormal communication between 2

epithelium is called as fistula.

• Latin – Fistula = Hollow pipe

• This hollow tract connect 2 body cavaties

or 1 cavity & the body surface


Causes of Fistula in Ano

• 1) Sequel of Ano rectal abscess

• 2) Tuberculosis

• 3) Ulcerative colitis – develop regional

proctitis

• 4) Cancer of Rectum or Anal canal

• 5) Lymphogranuloma venerum

• 6) H/O – Ano rectal or Gynaec Surgery


Types of Fistula in Ano

• 1) Low Level ( anal) – Normal

Fistulectomy may be compatible with

Ayurvedic Ksharutra

• 2) High Level ( anal ) – Modern

Fistulectomy has always a danger of

complication like Incontinence of

Faeces.So Ayurvedic Ksharsutra is better

option


Ksharsutra

• This is the Treatment of choice in fistula in

ano

• A surgery without Knife

• This is the only Ayurvedic surgery ,which

remains time tested & now even

recommended by Modern Ano rectal

Surgeon ( Dr.Raghunath Godbole –

recommends for High level fistula – to

avoid Incontinance of Urine)3/18/2015 10Prof.Dr.R.R.Deshpande

Examination of patient

• 1) P/R Examination in left lateral position &

with handgloves

• 2) Inspection for number of openings

,position & character of them

• 3) Discharge nature

• 4) Scar of previous surgery

• 5) Palpation of tract


P/R Examination


Perianal Abscess &

Fistula in Ano


Piles


Ano rectal problems


Formation of Haemorroids


Anal Fissure & Fistula


Can you imagine pain

of Anal fissure ?


Tracts of Fistulae


External & Internal piles


Kshar ( Chemical cautery)

• 1) Kshar = Substance ,which cuts the

devitalized tissue & having property of

cleansing ( Shodhan).

• 2) Kshar --- Alkali in nature

• A) Mrudu Kshar ( mild) = PH 8.4

• B) Madhya Kshar( moderate) = PH 9.2

• C) Tikshna Kshar (strong) = PH 9.4


Kshar

• 1) Mainly prepared by Herbs ,which

contain Sodium carbonate ,potassium

carbonate ,calcium oxide ,magnesium

oxide ,silica


Material for preparing

Ksharsutra• 1) Cotton thread number 10

• 2) Binding agent – Udumber Ksheer or

Gum ekesia

• 3) Kshar

• 4) Turmeric ( Haridra)

• 5) Water


Apamarga for Kshar


PH Values of Kshar


Ksharsutra Preparation


Making of Ksharsutra


Drying of Ksharsutra –

Dryer or oven


Ksharsutra – Ready to use


Preparation of Ksharsutra

• 1) Prepare solution of – Kshar(Apamarga or Arka) 1

part + Turmeric 3 parts + Udumbar ksheer or powder of

Gum ekesia

• 2) Add sufficient quantity of water .This solution should

not be too thick or too watery

• 3) Dip cotton thread in this solution .Dry it in cool place

• 4) Repeat this procedure for 11 times

• 5) After preparation,Kshar sutra is kept in Formalin

Chamber


Patient Examination

• Pain of the patient can be graded as 0 to 3

( No pain, Pain during defaecation

only,Pain releived by Sitz’s bath,Pain

releived by Analgesics)

• Burning sensation also can be graded as 0

to 3 (No Burning Sensation, Burning only

after defecation, Intermittent Burning &

Continuous burning)


Patient Examination

• Pus Dischage graded as 0 to 3 ( No

pus,Dischrge only during

defaecation,Intermittent discharge,Pus

dischage with soiling of cloth)


Patient Examination

• Perianal region is examined for –No of

openings, Location of openings,

Discharge,Colour of Peri anal skin,

Condition of sphincter on staining, Scar of

previous surgery

• By Palpation – Check Increased Local

Temperature, Tenderness, Feel of Tract


Patient Examination

• PR Examination or Digital Examination is

done in Left Lateral Position for Palpation

of Internal opening,Spincter tone & to

palpate any other Pathology like Tumour

or ulcer


Examination

• Proctoscopy

• Fistulogram

• Other base line Investigation like

Haemogram,

Urine,Stool,BSL,Urea,Creatinine,Cholester

ol,BT & CT,ECG etc


Drugs

• Haridra( Curcuma longa),

• Arka ( Calotropis procera),

• Udumber (Ficus racemosa),


Action of Ksharsutra

• Kshar has a action of Vrana

Shodhan,Lekhan & Ropan (

Cleansing,Scrapping & Healing)

• Kshara sutra does not allow to track close

abruptly & allow pus to drain

• Fistulous Track is cut by Chemical cautery

• UCT of Arka is 1 cm in 8 days & UCT of

Apamarga is 1 cm in 7 days


Comparison of Arka & Apamarga

• Although Arka is supposed to be stronger

by it’s Hot & cutting property ,in Practice

Apamaga Kshar can show better results

due to –

• Apamarga has good healing property &

less burning

• With Arka Ksharsutra,some times

unhealthy Hypergranulation is noted


Surgical Instruments


Procedure -- 1

• 1) Routine Lab

• 2) If H/O recurrence – Colonoscopy &

Fistulogram

• 3) Appropriate Local Anaesthesia( Spinal

at L4 & L 5)

• 4) Lithotomy position

• 5) Painting with spirit & povidone Iodine &

draping


Procedure -- 2

• 6) Inject Betadine + Hydrogen peroxide from

external opening & observe internal opening ,by

putting Seem’s speculum

• 7) Probing is done with Malleable probe of silver

,costing Rs.200 /- ,which is washed thoroughly

after procedure & kept in formalin Tablets

chamber ( Take precaution that not to create

false passage )


Procedure -- 3

• 8) Probe is expected to come out from

internal opening in the rectum ( confirmed

by injecting Betadine + Hydrogen peroxide

solution

• 9) Insert Ksharsutra & tight knot is applied

• 10) Go for Lord’s dilatation for painless

defecation


Ksharsutra application


Procedure -- 4

• 11) R/O any other pathology by doing P/R

& Proctoscopy

• 12) Insert Voveran( Diclofenac)

suppositories to avoid post operative pain

,with Jatyadi Taila varti as a lubricating

agent


Post operative Management

• 1) NBM for 3 to 4 hours

• 2) Soft & bland diet for a week

• 3) Anti biotics ( Inj Taxim 1 Gm I / V – BD ) &

Analgesics for a week

• 4) Then Saptavinshati Guggulu 2 BD +

• 5) Gandhak Rasayan 2 BD

• 6) Daily Sit’z bath

• 7) Change of Ksharsutra after 7 or 10 to 15

days


Ksharsutra Indication


Healing complete with

Kshar sutra


Warts on neck – another

indication for Ksharsutra


Planter Warts


Wart around anus


Wart on fingers


Advantage of Ksharsutra

• 1) Can perform under LA ( If it is low level &

patient is cooperative )

• 2) Huge wound can be avoided

• 3) No dressing ,No Pain

• 4) Short stay in hospital ( 1 or 2 days)

• 5) Much economical

• 6) Can attend normal duties from 3rd or 4th day &

on any vehicle

• 7) Negligible recurrence


IMP Advantage of Ksharsutra

• There is no fecal Incontinence in High

level fistula because

• 1) cutting & healing of fistulous Tract is

simultaneous procedure .This is chemical

cautery

• 2) This is surgery without knife ,so less

chances of getting fibers cut of sphincters


Dr.Bhalchandra N Deshpande

• Professor & HOD ,Dept of Surgery

,CARC,Nigdi ,Pune 44

• BAMS & AVP (Surgery)

• Article published in Ayurvidya magazine

,Jan 2012

• Got 1st prize of Best Article ,by Dr.Ranade

Foundation


Kshar sutra Learning


Book to purchase


CME on Ksharsutra


Start Ksharsutra Clinic


3/18/2015 Prof.Dr.R.R.Deshpande 59

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