Efficacy of Apamarga Kshara application and Sclerotherapy in the management of Arsha (1st and 2nd degree piles) - An open-labeled, randomized, controlled clinical trial

Coexisting pilonidal sinus and anal fistula: Successful management with minimal invasive Kshara Karma Technique and Ksharasutra therapy- A case report

Pilonidal sinus (PNS) is a nest of hair which typically presents as pits, pus discharge, and an abscess at the natal cleft region. In rare conditions where pilonidal abscess is not drained properly, it progresses posteriorly and reaches anal canal, eventually coexisting with anal fistula. Both are associated with a high recurrence rate despite surgical management. A 27 year old female patient presented with complaints of non-healing wound in the natal cleft region and pus discharge from wound for 2 months with a past surgical history for PNS. On local examination, a wound was seen at the natal cleft, secondary pit 3cm away with scar mark of the previous operation, and a digital rectal examination (DRE) revealed an internal opening at 6 o'clock position that was communicating with the previously operated PNS wound. The patient was diagnosed as a case of coexisting anal fistula and recurrent PNS. Patient was managed under spinal anaesthesia with interception of fistulous tract using Ksharasutra (Medicated alkaline thread), followed by Minimal Invasive Kshara Karma Technique (MIKKT) for PNS. Ksharasutra was sloughed out after the fifth week, and complete wound healing of PNS was achieved in six weeks. By interception of the fistulous tract, the length of the tract was reduced, which facilitated early wound healing and minimal scar mark formation. MIKKT also prevented bigger excision and wound formation, eventually reducing complete healing duration, and Kshara(a medicated alkali) applied caused chemical cauterization and hence prevented recurrence of pilonidal sinus.

Sclerotherapy for hemorrhoidal disease: systematic review and meta-analysis

BACKGROUND

This systematic review and meta-analysis aimed to evaluate the safety and efficacy of sclerotherapy methods for hemorrhoidal disease (HD) over the past 40 years.

METHODS

The review followed the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A comprehensive literature search was conducted, including studies reporting the use of sclerotherapy in patients with HD. Study eligibility criteria were defined, and data were extracted independently by the authors. Random-effects meta-analyses were performed to assess outcomes of interest.

RESULTS

Out of 1965 records identified, 44 studies met the inclusion criteria, involving 9729 patients. The majority of studies were conducted in Japan, followed by the UK, Italy, and Portugal. The median age of participants was 52 years, and the majority were male. The Goligher grade distribution indicated varying degrees of HD severity. Sclerotherapy was predominantly administered through anoscopy, with polidocanol being the most commonly used agent. The procedure was generally performed without pre-injection analgesia. The meta-analysis of 14 randomized controlled trials (RCTs) revealed that sclerotherapy was not inferior to control interventions in terms of success rate (risk ratio [RR] 1.00, 95% CI 0.71-1.41) and recurrence rate (RR 1.11, 95% CI 0.69-1.77), while resulting in fewer complications (RR 0.46, 95% CI 0.23-0.92).

CONCLUSIONS

This systematic review highlights the safety and efficacy of sclerotherapy for HD, which yields similar success rates and fewer complications compared to other conservative or surgical approaches. Further research is warranted to optimize sclerotherapy techniques and evaluate long-term outcomes.

REGISTRATION

PROSPERO 2023 CRD42023396910.