DELAYED PRIMARY CLOSURE FOLLOWING FISTULECTOMY in BHAGANDARA

Background: Bhagandara is an important disorder described in Ayurvedic Shalyatantra and is clinically correlated with fistula-in-ano. Established fistula-in-ano generally requires definitive surgical management. Following fistulectomy, the resultant wound may be managed by secondary intention or selected closure techniques. Delayed primary closure involves initially maintaining the wound open for drainage and wound care, followed by closure after satisfactory wound-bed preparation. Case Presentation: A 47-year-old male presented with pain in the anal and perianal region, purulent discharge, painful defecation, soiling of undergarments and fever. Clinical examination revealed an external opening at the 8 o'clock position and an internal opening at the 6 o'clock position, consistent with an intersphincteric fistula-in-ano. A posterior fissure-in-ano was also identified. Laboratory investigations showed haemoglobin 12 g/dL, total leukocyte count 12,000/mm³, platelet count 258,000/mm³ and serum creatinine 0.9 mg/dL. Fistulectomy with fissurectomy was performed. The wound was initially managed open with regular wound cleaning and antibiotic coverage. On postoperative day 7, healthy granulation tissue was present without slough or discharge. The wound edges were freshened and the wound was closed using Ethilon mattress sutures. Outcome: The sutures were removed on postoperative day 22. During 3 months of follow-up, pain and discharge had subsided, satisfactory wound healing was observed and no clinically evident recurrence was noted. Conclusion: This case demonstrates the clinical feasibility of delayed primary closure following fistulectomy in a selected patient with fistula-in-ano. The approach allows initial wound drainage and assessment of the wound bed before closure. Comparative studies with standardized outcome measures are required to establish its clinical utility.

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