CLASSIFICATION OF FISTULA-IN-ANO BY DIFFERENT AUTHORS Milligan Morgan’s & Goligher 1. 2. 3. 4. 5.

Ernst mile’s Melcheor,Goz Steltzner & Chericesco

Subcutaneous 1. Subcutaneous 1. Subcutaneous 1. Muscular Submucous 2. Subsphincteric 2. Submucous 2. Transsphincteric Low anal 3. Submucous 3. Ischiorectal 3. Extrasphincteric High anal 4. Intermuscular Anorectal 5. Pararectal (a) Ischiorectal (b) PelvirectaL

PARK’S CLASSIFICATION Intersphincteric (45%) Transsphincteric (30%) Suprasphincteric Extrasphincteric (20%) (5%)

1.Simple low track 1. Uncomplicated 1. Uncomplicated 1.Secondary to anal fistula 2.High blind track 2.High blind track 2.High blind track 2.Secondary to trauma 3.Hightrack with 3. Secondary to Anorectal rectal opening disease 4.High fistula without 4.Secondary to Pelvic perineal opening inflammation 5.Extrarectal extension 6.Fistula from pelvic disease MANAGEMENT PREVENTIVE CURATIVE

MEDICAL SURGICAL PARASURGICAL • Nidana Local Chhedan Raktamokshana parivarjana Systemic Bhedan Agnikarma • Suppuration Kshara karma of Pidaka Kshara sutra - General Kshar Varti - Local PRINCIPLES OF MANAGEMENT

NON SURGICAL • • Paste •

SURGICAL

PARA SURGICAL Seton Division

4% Silver nitrate Bismuth sulphate Quinine & Urithane

Fistulotomy Fistulectomy

KSHARA SUTRA

SETON DIVISION

Medicated Thread Apamarga Kshara – Lekhana Snuhi Ksheera – Proteolytic Haridra - Vrana shodana, ropana, & krimighna

Non medicated thread

Draining & Cutting Debridement – due to Kshara Faster healing Weekly changing of KS Loosening of the knot is usually not seen.

Draining & Cutting No debridement Delayed healing Weekly tightening of Knot Loosening of the knot is usually seen.

UCT – Specific –1cm. / 7 days

UCT - Non specific

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