ANATOMY OF PROSTATE AND URETHRA

                                                 ANATOMY OF PROSTATE AND URETHRA

shalya UG Syllabus

SHALYA TANTRA (UG) SYLLABUS

Theory Two Papers – 100 Marks

Each Practical - Viva voce – 100 Marks PAPER –I 100 Marks

Part – A 50 Marks

Definition of Shalya, Shalya Tantra and its importance. Introduction to Shalya Tantra: Historical background and progress made.  Target - Fluency in textual reading and comprehension.·  Preferable targets - Know recent developments and controversies.· Description of Yantra, Shastra, Anushastra: Definition, number, types, uses, Dosha, Guna, Karma. Relevant modern instruments.  Target - Basic understanding of the concepts of Yantra and Shastra. Acquaintance· with commonly used surgical instruments. Knowledge of textual descriptions.  Preferable targets - Knowledge about currently used surgical instruments, their· specifications, procurement sources etc. Nirjantukarana / Sterilization: Methods, types and its role in surgical practice.  Target - Basic surgical discipline of maintaining asepsis.·  Preferable targets- Knowledge of recently developed chemicals, instruments for· sterilization. Sangyaharan / Anaesthesia: Definition and Types. i. Local anaesthesia – Drugs, Techniques, Indications, Contraindications, Complications and their Management. ii. Regional and General anaesthesia- Drugs, Techniques, Indications, Contraindications, Complications and their Management.  Target-Basic knowledge of the drugs and instruments of anaesthesia. To observe the· process of induction, monitoring and recovery.  Preferable targets- Assisting and handling anaesthesia.· Trividha Karma – Purva Karma, Pradhana Karma and Paschat Karma.  Target- Capability to identify conditions which can affect the outcome of surgery in· pre, intra and post- operative period.  Preferable targets- Experience of handling incidents.· Ashtavidha Shastra Karma - Surgical procedures.  Targets- Appreciation and comprehension of concepts and indications of different· procedures.  Preferable targets –Hands on experience of surgical procedures.· 12 | U G S y l l a b u s 4 t h y e a r

 Yogya - Experimental Surgery.  Target –Appreciation and comprehension of concepts of Yogya. Idea of patient’s· safety in experimental training.  Preferable targets- Hands on training on mannequins.· Marma: Nirukti, types, description and importance.  Target –Clinical application of concepts of marma.·  Preferable targets- Study of relevance of marma in the light of current anatomical· and surgical knowledge. Kshara and Kshara Karma: i. Nirukti, Pradhanyata, Guna, Dosha, Karma, Prakara, Yogya, Ayogya, Procedure, Upadrava and Chikitsa. ii. Kshara nirmana vidhi, knowledge of Kshara Varti, Taila and Pichu. iii. Kshara Sutra – Preparation, Indications, Contraindications and Method of application, Complications and their Management.  Target – Capability to identify and practice the use of kshara, kshara sutra in· common clinical conditions.  Preferable targets – Broader knowledge of current trends and ongoing researches in· kshara application. Agnikarma: Mahatva, Upakarana, Vidhi, Akruti bheda, Yogya, Ayogya and Upadrava Chikitsa. Contemporary techniques and tools of Agnikarma.  Target - Capability to appreciate the clinical indications and comprehend Agnikarma· procedure.  Preferable targets - Hands on experience of use of cautery in surgical practice.· Raktamokshana: Mahatva, Prakara - Siravyadha, Pracchanna, Shringa, Alabu, Jaloukavacharana – Yogya, Ayogya, Procedure, Upadrava and Chikitsa.  Target- Capability to appreciate and comprehend clinical indications of· Jaloukavacharana and other Raktamokshana procedures.  Preferable targets - Uses of bloodletting in current therapy.· Bandha Vidhi – Prayojana, Dravya, Indications, Contraindications, Prakara, Upadrava, Pichu, Plota, Kavalika and Vikeshika.  Target- Hands on experience of techniques of bandaging.·  Preferable targets - New generation of bandaging and splintage tools.· Pranasta Shalya and Nirharana Upaya.  Target – Importance of concepts of Sushruta in the management of Shalya and· concerns of patient safety. Identification and management of foreign bodies.  Preferable targets - Current concepts and diagnostic tools of dealing with foreign· bodies. 13 | U G S y l l a b u s 4 t h y e a r

Fluid, Electrolyte, Acid Base Balance and Nutrition: i. Introduction of physiology of fluids and electrolytes. ii. Dehydration and over hydration. iii. Specific electrolyte loss, Acidosis, Alkalosis, Symptomatology and Management. iv. Electrolyte changes in specific diseases like pyloric stenosis, intestinal obstruction and anuria. v. Various replacement fluids in surgery, mode of administration and complications. vi. Nutrition.  Target – Capability to identify and manage fluid and electrolyte imbalance. Ability to· administer parenteral fluid.  Preferable targets - Advanced techniques of fluid and electrolyte assessment and· management. Rakta Mahatwa, Raktasrava / Haemorrhage: Prakara and Lakshana. i. Raktastambhana – Haemostasis. ii. Blood Transfusion –Blood groups, Compatibility, Indications, Contraindications and Complications with Management. iii. Component therapy.  Target-Knowledge of achieving haemostasis in haemorrhage.·  Preferable targets - Detailed knowledge of blood bank techniques.· Antibiotics, analgesics, anti-inflammatory and emergency drugs in surgical practice.  Target – Working knowledge of commonly used drugs.·  Preferable targets - Advanced pharmacological study of the above drugs.· Diagnostic techniques – X-ray, Imaging techniques, Ultrasonography, CAT Scan, MRI, Biopsy / Cytological study.  Target- Knowledge of proper indications for optimum investigational tools and their· interpretation.  Preferable targets - Capability to work independently in the field of diagnostic· techniques.

Part - B 50 Marks Shat Kriyakala in surgical practice.  Target- Clinical utility of the concepts.·  Preferable targets - Applied aspects of Kriyakalas in the light of current concepts of· pathogenesis. Nirukti, Nidana, Samprapti, Prakara, Lakshana, Sadhya-asadhyata, Upadrava and Chikitsa of the following disorders. i. Vranashotha - Inflammation ii. Vidhradi - Abscess iii. Pidika - Boils iv. Nadi Vrana - Sinus / Fistulae v. Vrana Granthi - Keloid / Hypertrophic scar 14 | U G S y l l a b u s 4 t h y e a r vi.

Marmagata - Shock vii. Kotha – Gangrene and Principles of Amputation. viii. Granthi - Cyst ix. Arbuda - Tumour  Target-Clinical application of the concepts.·  Preferable targets - Hands on experience of management of different conditions.· Vrana – Nirukti and Prakara i. Nija Vrana – Nidana, Samprapti, Vrana Vasthu, Prakara, Lakshana, Vrana Pariksha – Sthana,Vrana Akruti, Srava, Gandha, Vedana. Vrana Avastha- Dustavrana, Shuddha Vrana, Ruhyamana Vrana, Samyak Roodha Vrana, Vrana Sadhya-asadhyatha and Vrana Upadrava. ii. Vrana Chikitsa – Pathya-apathya and Shashti Upakrama,Vranitagara and Rakshakarma. iii. Agantuja Vrana : a. Sadyo Vrana - Traumatic wounds – Nidana, Prakara, Lakshana, Upadrava and Chikitsa. b. Management of bites and stings. iv. Dagdha Vrana – Burns and scalds. v. Ulcer - Types and their management. vi. Wound healing stages and their management. vii. Pramehapidaka - Diabetic carbuncle and wounds.  Target - Clinical application of the concepts.·  Preferable targets - Hands on experience of management of different conditions.· Twak Vikara - Nidana, Samprapti, Lakshana and Chikitsa of Chippa – Paronychia, Kadara – Corn and Kshudra rogas.  Target - Clinical application of the concepts.·  Preferable targets - Hands on experience of management of different conditions.· Manya Vikara – Nidana, Samprapti, Lakshana and Chikitsa of Galaganda – Goitre, Gandamala, Apachi –Lymphadenitis, Pashanagardhabha – diseases of parotid gland.  Target-Clinical application of the concepts.·  Preferable targets - Hands on experience of management of different conditions.· Sira Vikara - Venous disorders – Superficial and Deep venous thrombosis, Haemangioma, Varicose veins - Diagnosis and their Management.  Target - Clinical application of the concepts.·  Preferable targets· - Hands on experience of management of different conditions. Dhamani Vikara - Arterial disorders – Nidana, Samprapti, Lakshana and Chikitsa of Aneurysm, Buerger’s disease, Atherosclerosis, Raynaud’s disease.  Target - Clinical application of the concepts.·  Preferable targets - Hands on experience of management of different conditions.· Snayu Vikara - Diseases of tendons and ligaments – Tennis elbow, Ganglion and their Management.  Target - Clinical application of the concepts.· 15 | U G S y l l a b u s 4 t h y e a r

 Preferable targets - Hands on experience of management of different conditions.· Care of AIDS - HIV and hepatitis infected patients.  Target - Knowledge of safety precautions.·

PAPER - II 100 Marks Part - A 50 Marks

 Bhagna – Skeletal injuries: Prakara including pathological fracture, Samanya Lakshana, Upadrava and Chikitsa. Description of fracture of following bones with Clinical features, Diagnosis, Complications and Management – scapula, clavicle, humerus, radius, ulna, femur, patella, tibia and pelvis bones. Sandimoksha - Dislocation: Dislocation of following joints with Clinical features, Diagnosis, Complications and Management of shoulder, elbow and hip.  Target - Clinical utility of the concepts.·  Preferable targets - Hands on experience of management of different conditions.· Diseases of bone: Aetiopathogenesis, Classification, Clinical features, Diagnosis, Complications and Management of Congenital anomalies, Osteomyelitis, Cysts, Tumours and Tuberculosis.  Target - Clinical utility of the concepts.·  Preferable targets - Hands on experience of management of different conditions.· Cranio-cerebral injuries: Mechanism, Pathology, Classification, Investigations, Complications and primary management.  Target - Clinical utility of the concepts.·  Preferable targets - Hands on experience of management of different conditions.· Diseases of Spine: Mechanism, Pathology, Classification, Investigations, Complications and primary management of Tuberculosis, Ankylosing Spondylitis and Disc prolapse.  Target - Clinical utility of the concepts.·  Preferable targets - Hands on experience of management of different conditions.· Diseases of breast: Aetiopathogenesis, Classification, Clinical features, Diagnosis, Complications and Management of Sthana Vidradhi - Breast abscess and Sthana Arbuda - Breast tumours.  Target - Clinical utility of the concepts.·  Preferable targets - Hands on experience of management of different conditions.· Diseases of chest: Aetiopathogenesis, Classification, Clinical features, Diagnosis, Complications and Management of Chest injury, Pleural effusion, Pleurisy and Tumours.  Target - Clinical utility of the concepts.·  Preferable targets - Hands on experience of management of different conditions.· Diseases of esophagus: Aetiopathogenesis, Classification, Clinical features, Diagnosis, Complications and Management of Congenital anomalies, Oesophagitis, Varices, Ulcer and Tumours. 16 | U G S y l l a b u s 4 t h y e a r  Target - Clinical utility of the concepts.·  Preferable targets - Hands on experience of management of different conditions.· Gulma Roga - Nidana, Prakara, Lakshana, Upadrava and Chikitsa. Shoola vyadhi - Nidana, Prakara, Lakshana, Upadrava and Chikitsa.  Target - Clinical utility of the concepts.·  Preferable targets - Hands on experience of management of acute abdomen.· Udara Roga: Aetiopathogenesis, Classification, Clinical features, Diagnosis, Complications and Management of Jalodara - Ascites, Chidrodara – Perforation, Peritonitis and Badhagudodara-Intestinal obstruction.  Target - Clinical utility of the concepts.·  Preferable targets - Hands on experience of management of different conditions.· Diseases of stomach and duodenum: Aetiopathogenesis, Classification, Clinical features, Diagnosis, Complications and Management of Pyloric Stenosis, Peptic Ulcer and Tumours.  Target - Clinical utility of the concepts.·  Preferable targets - Hands on experience of management of different conditions.· Diseases of small intestine: Aetiopathogenesis, Classification, Clinical features, Diagnosis, Complications and Management of Tuberculosis, Obstruction and Perforation.  Target - Clinical utility of the concepts.·  Preferable targets - Hands on experience of management of different conditions.· Diseases of large intestine - Aetiopathogenesis, Classification, Clinical features, Diagnosis, Complications and Management of Tuberculosis, Obstruction, Perforation, Tumours, Appendicitis, Crohn’s disease and Ulcerative Colitis.  Target - Clinical utility of the concept.·  Preferable targets - Hands on experience of management of different conditions.· Diseases of Rectum and Anal Canal – Aetiopathogenesis, Classification, Clinical features, Diagnosis, Complications and Management of Congenital disorders, Arshas - Haemorrhoids, Parikartika - Fissure-in-ano, Bhagandara - Fistula-in-ano, Guda Vidradi - Anorectal abscesses, Gudabhramsa - Rectal prolapse, Sanniruddaguda - Anal stricture, Incontinence, Rectal Polyp and Tumours.  Target - Clinical utility of the concepts.·  Preferable targets - Hands on experience of management of different conditions.· Abdominal injuries and their management.  Target - Clinical utility of the concepts.·  Preferable targets - Hands on experience of management of different conditions.· 17 | U G S y l l a b u s 4 t h y e a r

 Part – B 50 Marks 

Diseases of Liver: Aetiopathogenesis, Classification, Clinical features, Diagnosis, Complications and Management of Yakrit Vidhradi - Abscess, Neoplasia, Portal hypertension and Yakritdalyodar –Hepatomegaly.  Target - Clinical utility of the concepts.·  Preferable targets - Hands on experience of management of different conditions.· Diseases of Gallbladder: Aetiopathogenesis, Classification, Clinical features, Diagnosis, Complications and Management of Cholecystitis, Cholelithiasis, Obstructive jaundice and Tumours.  Target - Clinical utility of the concepts.·  Preferable targets - Hands on experience of management of different conditions.· Diseases of Pancreas: Aetiopathogenesis, Classification, Clinical features, Diagnosis, Complications and Management of Pancreatitis, Cysts of Pancreas and Tumours.  Target - Clinical utility of the concepts.·  Preferable targets - Hands on experience of management of different conditions.· Diseases of Spleen – Aetiopathogenesis, Classification, Clinical features, Diagnosis, Complications and Management of Pleehodara – Splenomegaly and Splenic rupture.  Target - Clinical utility of the concepts.·  Preferable targets - Hands on experience of management of different conditions.· Diseases of Kidney and Ureters - Aetiopathogenesis, Classification, Clinical features, Diagnosis, Complications and Management of Congenital anomalies, Polycystic kidney, Injuries, Perinephric abscess, Calculus and Neoplasms.  Target - Clinical utility of the concepts.·  Preferable targets - Hands on experience of management of different conditions.· Diseases of Urinary bladder – Aetiopathogenesis, Classification, Clinical features, Diagnosis, Complications and Management of Congenital anomalies, Injuries, Ashmari - Vesical Calculus, Cystitis and Neoplasms.  Target - Clinical utility of the concepts.·  Preferable targets - Hands on experience of management of different conditions.· Mutraghata and Mutrakrichra - Aetiopathogenesis, Classification, Clinical features, Diagnosis, Complications and Management. Retention of urine.  Target - Clinical utility of the concepts.·  Preferable targets - Hands on experience of management of different conditions.· Diseases of Prostate - Aetiopathogenesis, Classification, Clinical features, Diagnosis, Complications and Management of Prostatitis, Prostatic abscess, Benign Enlargement of Prostate and Carcinoma of Prostate.  Target - Clinical utility of the concepts.·  Preferable targets - Hands on experience of management of different conditions.· 18 | U G S y l l a b u s 4 t h y e a r Diseases of Urethra – Aetiopathogenesis, Classification, Clinical features, Diagnosis, Complications and Management of Urethritis, Stricture and Rupture.  Target - Clinical utility of the concepts.·  Preferable targets - Hands on experience of management of different conditions.· Diseases of Penis: Aetiopathogenesis, Classification, Clinical features, Diagnosis, Complications and Management of Congenital anomalies, Niruddhaprakasha -Phimosis, Parivartika -Paraphimosis, Avapatika - Prepuceal ulcer, Arbuda- Tumours and Lingarsha - Penile Warts.  Target - Clinical utility of the concepts.·  Preferable targets - Hands on experience of management of different conditions.· Diseases of Scrotum and Testis: Aetiopathogenesis, Classification, Clinical features, Diagnosis, Complications and Management of Epididymo-orchitis, Epididymal cyst, Scrotal filariasis, Shukrashmari - Seminal calculus, Torsion of testis, Ectopic testis, Undescended testis and Tumours. Vriddhi Roga: Aetiopathogenesis, Classification, Clinical features, Diagnosis, Complications and Management of Mutravriddhi – Hydrocele.  Target - Clinical utility of the concepts.·  Preferable targets - Hands on experience of management of different conditions.· Antra Vriddhi – Aetiopathogenesis, Classification, Clinical features, Diagnosis, Complications and Management of Hernia - Inguinal, Femoral, Epigastric, Umbilical, Incisional and rare forms of Hernia.  Target - Clinical utility of the concepts.·  Preferable targets - Hands on experience of management of different conditions.· PRACTICALS Content of Practicals: 1. Identification, uses, demonstration of surgical instruments and methods of sterilization. 2. Training of case taking, bed side clinicals and case presentation. 3. Demonstration and Practical training in Anaesthesia. 4. Training to develop skills in following Parasurgical and other procedures i. Kshara Karma ii. Agnikarma iii. Kshara Sutra iv. Raktamokshana v. Application of bandages and splints vi. Catheterization vii. Wound management procedures like Parisheka and Patradana viii. Ryle’s tube aspiration ix. Injections -Intramuscular / Intravenous / Subcutaneous / Intradermal x. Incision and drainage of abscess xi. Suturing of open wounds 5. Observation of following procedures 19 | U G S y l l a b u s 4 t h y e a r i. Circumcision ii. Hydrocele iii. Hernial repair iv. Vasectomy v. Haemorrhoidectomy vi. Fistulectomy vii. Fissurectomy viii. Appendecectomy ix. Cholecystectomy 6. Training of Surgical Emergencies and Management. Clinical Training (Indoor and Outdoor) 09 Months  Shalya (Samanya) 03 Months (atleast one month· in OT)  Shalya (Kshara and Anushastra Karma) 03 Months (atleast one· month in OT)  Asthi and Sandhi Chikitsa (Orthopaedics and 02 Months· Trauma)  Anaesthesia 15 days·  Radiology 15 days· Distribution of Marks 1) Daily records - 10 Marks 2) Instruments - 20 Marks 3) Short case - 10 Marks 4) Long case - 20 Marks 5) Viva – voce - 40 Marks Total - 100 Marks Reference Books 1. Sushruta Samhita 2. Ashtanga Sangraha 3. Ashtanga Hridaya 4. Charaka Samhita 5. The Surgical instruments of the Hindus - Girindranath Mukhopadhyaya 6. Shalya Tantra Samuchchaya - Pandit Ramadesh Sharma 7. Shalya Vigyan (Part 1-2) - Dr. Surendra Kumar Sharma 8. Shalya Samanvaya (Part 1-2) - Vd. Anantaram Sharma 9. Shalya Pradeepika - Dr. Mukund Swaroop Verma

RENAL CALCULUS

1. 1 KIDNEY STONE 
2. 2. OBJECTIVES • INTRODUCTION • INCIDENCE • STONE FORMATION • TYPES OF STONES • CLINICAL MANIFESTATIONS • CAUSES & RISK FACTORS • PATHOPHYSIOLOGY • TREATMENT & PREVENTION
3. 3. INTRODUCTION  Kidney Stones, also known as renal calculus or nephrolith, are small, hard deposits of mineral and acid salts on the inner surfaces of the kidneys.  If stones grow to sufficient size they can cause blockage of the ureter.  kidney-------- stone (calcium) gall bladder---- stone (cholesterol oxalates) intestine ------- jejunum (hard substance)
4. 4. INCIDENCE  Urinary calculi are more common in men than in women.  Incidence of urinary calculi peaks between the 3rd and 5th decades of life.  80% of stones under 2mm in size  90% of stones pass through the urinary system spontaneously  There is seasonal variation with stone occurring more often in the summer months suspecting the role of dehydration in this process.
5. 5. STONE FORMATION  Highly concentrated urine constituents crystallize and harden to form calculi.  Kidney stones form when our urine contains more crystal- forming substances — such as calcium, oxalate and uric acid.  At the same time, our urine may lack substances that prevent crystals from sticking together, creating an ideal environment for kidney stones to form.  The crystals get deposited on the nucleus and continue to grow. These can some times adhere to the renal papillae.
6. 6. TYPES OF KIDNEY STONES  Calcium oxalate  Calcium phosphate  Struvite  Uric acid  Cystine
7. 7. Calcium stones: Most kidney stones are calcium stones, usually in the form of calcium oxalate and calcium phosphate. Oxalate is a naturally occurring substance found in food. Some fruits and vegetables, as well as nuts and chocolate, have high oxalate levels. Our liver also produces oxalate. IN ALKALINE URINE  ENLARGES RAPIDLY  TAKE SHAPE OF CALYCES  STAGHORN  CALCIUM PHOSPHATE
8. 8. Uric Acid: This type of kidney stone is more common in men than in women. They can occur in people with gout or those going through chemotherapy. Struvite: This type of stone is found mostly in women with urinary tract infection. These stones can be quite large and cause urinary obstruction. Cystine: Cystine stones are rare. They occur in both men and women who have the genetic disorder cystinuria. Other: Other, rarer types of kidney stones also can occur. Such as XANTHINE STONES, DIHYDROXY ADENINE STONE, SILICATE STONES etc.
9. 9. CLINICAL MANIFESTATIONS  Severe flank pain  Abdominal pain  Nausea and vomiting  Fatigue  Elevated temperature, BP, and respirations  Steady Pain  Pain on urination; Pink, red or brown urine  Oliguria and anuria in obstruction  Hematuria  Renal colic  Hydronephrosis
10. 10. CAUSES  Supersaturation of urine is the key to stone formation  Imbalance of pH in urine  Gout  Hyperparathyroidism  Inflammatory Bowel Disease  UTI (Urinary Tract Infections)  Dehydration  Crystal aggregation
11. 11. RISK FACTORS HIGH MINERAL CONTENT IN DRINKING WATER DEHYDRATION FAMILY OR PERSONAL HISTORY DIETARY INTAKE BEING OBESE
12. 12. PATHOPHYSIOLOGY • Slow urine flow, resulting in super saturation of the urine. • Damage to the lining of the urinary tract • Decreased inhibitor substances in the urine that would otherwise prevent super saturation and crystalline aggregation.
13. 13. DIAGNOSTIC STUDIES RETROGRADE PYELOGRAM DRUG THERAPY- Opioids,NSAIDs. 24 HOUR URINE SPECIMEN LAB INVESTIGATION S
14. 14. TREATMENT & PREVENTION Acute Treatment:  Pain Medication!!  Strain urine for stones  Keep Hydrated  Ambulation  Diet Restrictions  Emotional Support  Invasive Procedure (may be necessary)
15. 15. Surgical Procedures Lithotripsy: used sound wave to break up large stones into smaller fragments allowing it to pass through the urinary tract.  Extracorporeal Shock-Wave Lithotrypsy (ESWL)  Percutaneous Ultrasonic  Electrohydraulic  Laser Surgical Therapy  Nephrolithotomy (Kidney)  Pyelolithotomy (Renal Pelvis)  Ureterolithotomy (Ureter) Basket Extraction/Ureteroscopy
16. 16. Lithotripsy Basket Extraction
17. 17. PREVENTION  Hydration  Drink 3 liters of fluid per day (14 cups)  Ideally water  Lemonade (citrate decrease stone formation)  Diet  Low sodium & calcium intake.  Avoid intake of oxalate-containing foods (eg, spinach,strawberries, rhubarb, tea, peanuts, wheat bran).  Low protein intake is required.  Exercise/Increase Activity -Avoid activities leading to sudden increases in environmental temperatures that may cause excessive sweating and dehydration.
18. 18. EAT WELL, STAY WELL….
19. 19. MEDICATIONS Pain relief may require narcotic medications. The presence of infection requires treatment with antibiotics. Other medications include: allopurinol for uric acid stones diuretics sodium bicarbonate or sodium citrate phosphorus solutions
    
    
    
    

DR.BHARAT ROKADE

HISTORICAL ASPECTS OF FISTULA-IN-ANO.

Brief reference to Fistula-in-ano was mentioned in the Code of Hammurabi even

as early as 12th century BC.

Hippocrates (400-365 BC) thought that the trauma and abscess were the causes of

fistula. He advised early drainage of an abscess even open while still unripe to prevent

fistula formation. Various forms of treatment were used in fistula. The non-operative

procedures of ligation using horse hair and raw lint was given as the method of choice in

the majority of cases. If ligation failed then surgical procedure of cutting down on the

tract was directed. The wound is to be allowed to heal by granulations from the bottom.

The use of the syringe and caustic substances are advocated to distend the tract.

Celsus (25 BC-50? AD) performed the ligature after having accomplished a total

excision of the superficial plane and the only incision which is interrupted in its central

part is performed by following a probe. He pointed out the dangers of incising to a high

internal opening and used a tent in such cases. The modern fistulotomy in 2 stages and

fistulectomy are repetitions of Celsus’s treatment.

Heliodorus (c. 1st century AD) and Antyllos (c. 150 AD) in Rome performed the

incision by following a flat probe.

Galen (130-200 AD) treated fistulas with drainage and chemical cauterisation.

Leonidas of Alexandria (c. 200AD) and Aetios of Amida (502-575 AD) performed the

incision after previous ligature and pulling with a folded probe.

Paul of Aegina (625-690 AD) used a bent bistoury and left the Hippocratic

ligature for fearful patients.

KSHARSUTRA

Dr. Bharat Rokade.

Fistulogram and
Ksharsutra Application