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VOLUME 3 , ISSUE 3 ( July-September, 2019 ) > List of Articles

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Ayurvedic Management of Fistula in Ano: A Systematic Review Protocol

KM Pratap Shankar, GN SreeDeepthi, KS Rohit, GK Swamy

Keywords : Ayurvedic management, Bhagandara, Fistula in ano, Kshara Sutra, Systematic review, Systematic review protocol,Ayurveda

Citation Information : Pratap Shankar K, SreeDeepthi G, Rohit K, Swamy G. Ayurvedic Management of Fistula in Ano: A Systematic Review Protocol. J Res Ayurvedic Sci 2019; 3 (3):100-105.

DOI: 10.5005/jras-10064-0081

License: CC BY-NC 4.0

Published Online: 00-09-2019

Copyright Statement:  Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: Fistula in ano is considered to be complicated and vicious due to its nature of recurrences and exacerbations. Ayurveda includes this disease under the list of AstaMahagada (eight serious diseases that are difficult to treat by nature itself) due to this attribute. Ayurvedic literature offers various effective and safe management strategies for fistula in ano. Several works have been conducted to prove the efficacy and effectiveness of various treatment modalities mentioned in Ayurvedic texts. Kshara sutra, Kshara karma, Agnikarma, and Ksharavarti are a few to name in this list. A lacuna exists in not analyzing or compiling these works. Hence, the purpose of this systematic review is to generate evidence for efficacy, effectiveness, and safety profile of Ayurvedic interventions in the management of fistula in ano. Materials and methods: Electronic search from various online databases and clinical trial registers will be done. Manual search for gray literatures will be done from various colleges and universities. There will be no language restrictions. Three authors independently will screen all citations and abstracts to identify potentially eligible trials. Based on the inclusion criteria, full articles will be evaluated and disagreements will be discussed among the three authors. Data extraction from the included studies will be done by the three reviewers independently with extraction forms containing methods, participants, interventions, comparators/controls, and outcomes. Each of the included trials will be assessed for risk of bias. Primary data analysis will be done for both qualitative and quantitative data. Heterogeneity among trials will be assessed by inspecting forest plots. If heterogeneity is detected, and it is still considered clinically meaningful to combine studies, a random-effects model will be used. Meta-analysis will be done for pooled estimates and others would be presented as narrative synthesis and shall be represented in tabular and graphical forms. Dissemination: The systematic review will be published in a peer-reviewed journal. It will also be disseminated electronically and in print. The review may guide healthcare practices and policy framing regarding the treatment of fistula in ano with Ayurvedic interventions. Study registration: PROSPERO registration no. CRD42019131911.


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  1. García-Olmo D, Van Assche G, Tagarro I, et al. Prevalence of anal fistulas in europe: systematic literature reviews and population-based database analysis. Adv Ther 2019;36(12):3503–3518. DOI: 10.1007/s12325-019-01117-y.
  2. Vyas AK, Katlana A, Singh A, et al. Incidence of low fistula in ano and results of fistulotomy in rural tertiary centre. Ann Int Med Den Res 2017;3(3):SG28–SG30. DOI: 10.21276/aimdr.2017.3.3.SG9.
  3. Raghavaiah NV. Anal fistula in India. Int Surg 1976;61(4):243–245.
  4. Song KH. New techniques for treating an anal fistula. J Korean Soc Coloproctol 2012;28(1):7–12. DOI: 10.3393/jksc.2012.28.1.7.
  5. García-Aguilar J, Belmonte C, Wong DW, et al. Cutting seton versus two-stage set on fistulotomy in the surgical management of high anal fistula. Br J Surg 1998;85(2):243–245. DOI: 10.1046/j.1365-2168.1998.02877.x.
  6. Williams JG, MacLeod CA, Rothenberger DA, et al. Seton treatment of high anal fistulae. Br J Surg 1991;78(10):1159–1161. DOI: 10.1002/bjs.1800781004.
  7. Pearl RK, Andrews JR, Orsay CP, et al. Role of the seton in the management of anorectal fistulas. Dis Colon Rectum 1993;36(6):573–577. DOI: 10.1007/BF02049864.
  8. Hamalainen KP, Sainio AP. Cutting seton for anal fistulas: high risk of minor control defects. Dis Colon Rectum 1997;40(12):1443–1446. DOI: 10.1007/BF02070710.
  9. Gustafsson UM, Graf W. Excision of anal fistula with closure of the internal opening: functional and manometric results. Dis Colon Rectum 2002;45(12):1672–1678. DOI: 10.1007/s10350-004- 7257-y.
  10. Kreis ME, Jehle EC, Ohlemann M, et al. Functional results after transanal rectal advancement flap repair of trans-sphincteric fistula. Br J Surg 1998;85(2):240–242. DOI: 10.1046/j.1365-2168.1998.00557.x.
  11. Loungnarath R, Dietz DW, Mutch MG, et al. Fibrin glue treatment of complex anal fistulas has low success rate. Dis Colon Rectum 2004;47(4):432–436. DOI: 10.1007/s10350-003-0076-8.
  12. Bubbers EJ, Cologne KG. Management of complex anal fistulas. Clin Colon Rectal Surg 2016;29(1):43–49. DOI: 10.1055/s-0035- 1570392.
  13. Vaidya Jadavji Trikamji Acharya, editor. Caraka Samhita of Agnivesha, Chikitsa Sthana, Ch. 12, Ver. 96-97. Varanasi: Chaukamba Krishnadas Academy; 2009. p. 490.
  14. Singhal GD, editor. Susruta Samhita of Susruta, Vol. 1, Sutra Sthana, Ch. 33, Ver. 4. Delhi: Chaukhamba Sanskrit Pratishthan; 2007. p. 274.
  15. Singhal GD, editor. Susruta Samhita of Susruta, Vol. 1, Nidana Sthana, Ch. 4, Ver. 3. Delhi: Chaukhamba Sanskrit Pratishthan; 2007. p. 530.
  16. Singhal GD, editor. Susruta Samhita of Susruta, Vol. 1, Nidana Sthana, Ch. 4, Ver. 3–9. Delhi: Chaukhamba Sanskrit Pratishthan; 2007. p. 530–532.
  17. Hari Shastri Paradakara, editor. Vagbhata's Astanga Hrdayam, Uttara Sthana, Ch. 28, Ver. 5-20. Varanasi: ChaukhambhaSurbharatiPrakashan; 2010. p. 878.
  18. Singhal GD, editor. Susruta Samhita of Susruta, Vol. 2, Chikitsa Sthana, Ch. 8, Ver. 4,38-52. Delhi: Chaukhamba Sanskrit Pratishthan; 2007. p. 240–242.
  19. Singhal GD, editor. Susruta Samhita of Susruta, Vol. 2, Chikitsa Sthana, Ch. 8, Ver. 4-11. Delhi: Chaukhamba Sanskrit Pratishthan; 2007. p. 241.
  20. Hari Shastri Paradakara, editor. Vagbhata's Astanga Hrdayam, Uttara Sthana, Ch. 28, Ver. 27. Varanasi: ChaukhambhaSurbharatiPrakashan; 2010. p. 879.
  21. Singhal GD, editor. Susruta Samhita of Susruta, Vol. 2, Chikitsa Sthana, Ch. 17, Ver. 29-33. Delhi: Chaukhamba Sanskrit Pratishthan; 2007. p. 319.
  22. Sharma PV, editor. Cakradatta, Nadivranaadhikaram, Ch. 42, Ver. 9. Delhi: Chaukhambha Orientalia; 2007. p. 373.
  23. Pandit Kashinatha Shastri, editor. Rasatarangini. Delhi: Motilal Banaridas; 1979. p. 745.
  24. Singhal GD, editor. Susruta Samhita of Susruta, Vol. 2, Sutra Sthana, Ch. 11, Ver. 4. Delhi: Chaukhamba Sanskrit Pratishthan; 2007. p. 86.
  25. Rao D. Biochemical and histological aspects of effects of ‘Kshara sutra’ on anorectal tissue in the treatment of fistula in ANO and other problems, PhD thesis, Pune, India: Savitribai Phule Pune University; 2003.
  26. Kurapati VK, Nishteswar K. Management of Ano-Rectal disorders by Kṣārasūtra: A clinical report. Anc Sci Life 2014;34(2):89–95. DOI: 10.4103/0257-7941.153467.
  27. Baghel MS. Gandhinagar: Mridu Ayurvedic Publication and Sales; 2006. Researches in Ayurveda; 2005.
  28. Tillu G, Chopra A, Sarmukaddam S, et al. Ayurveda interventions for rheumatoid arthritis. Cochrane Database Syst Rev 2015;3:CD011569. DOI: 10.1002/14651858.CD011569.
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