“An Open Label Single Arm Clinical Study to Revalidate Sushrutokta Langalaka Incision Followed by Agnikarma in Vataja Bhagandara”

Abstract

Bhagandara is a chronic and recurrent anorectal disorder that causes considerable discomfort, pain, and psychological distress to the patient. Though not life-threatening, it severely affects the quality of life. In modern medicine, Fistula-in-Ano usually originates from an anal gland infection leading to abscess and tract formation. Despite various surgical advancements, its management continues to be a challenge due to frequent recurrence and risk of sphincter injury. In Ayurveda, Acharya Sushruta has described Bhagandara as one among the Ashtamahagada because of its chronicity and difficult management. Among its five types, Vataja Bhagandara is characterized by severe pain, dryness, and hard swelling with scanty discharge, indicating Vata predominance. Acharya Sushruta has emphasized Chedana Karma (incision) as the prime line of treatment and mentioned various incision types according to the Dosha predominance and nature of the tract. For Vataja Bhagandara, he advocated the Langalaka incision, suitable for deep and painful tracts. Following the incision, Agnikarma (therapeutic cauterization) is advised to destroy residual unhealthy tissue, prevent recurrence, and promote healing.

METERIALS AND METHODS

Subjects fulfilling the Diagnostic criteria approaching OPD and IPD of JSS Ayurveda Medical college and Hospital, Mysuru. Medical camps and other referrals were considered. An open-labelled clinical trial design was adopted for this study, comprising a single group of 30 subjects. The subjects were selected based on specific diagnostic, inclusion, and exclusion criteria. They were treated with Langalaka ‘T’-shaped incisions, which were made around the external opening of the fistulous tract, this was followed by Agnikarma performed using bipolar cautery.

RESULTS

Based on the assessment criteria and overall outcomes of the treatment, implementing the Sushrutokta Langalaka incision followed by excision of the fistulous tract and Agnikarma performed using bipolar cautery yielded better results in terms of postoperative pain reduction, discharge control, and wound healing. This procedure effectively addressed the ramifications of the fistulous tract, thereby minimizing the chances of recurrence and promoting early wound healing.

CONCLUSION

The study demonstrated highly significant results in reducing Vedana and Srava. It also showed promising outcomes in decreasing the size of the wound and induration, promoting the development of healthy granulation tissue, and achieving early wound healing. Hence, it can be concluded that the Sushrutokta Langalaka incision followed by Agnikarma provided results that were both statistically and clinically significant, with faster wound healing rates and reduced recurrence rates.