ayurvedic management of pilonidal sinus2

LORD DHANVANTARI

Dr. U.R.Sekhar.NamburiM.D(Ay)

Asst. Prof. Dept. of P.G. Studies in Shalya Tantra

S.D.M. COLLEGE OF AYURVEDA & Hospital

HASSAN

INTRODUCTION

• Incidence – 0.75/1000 Individuals

• Age – Common age around 25 years

• Sex – Male

• Recurrence is more even the incidence is less.

NADA = means a “REED “ That which is having a track likes a reed.

The nature of the wound which remains unhealed with the characteristic of oozing or discharge of pus is called as Nadi vrana.

“NADI” – a track ;

“VRANA” - an ulcer An ulcer which is having a tack is called as “Nadivrana”.

DEFINITION OF NADI VRANA

• If it is treated by quack• When the surgeon drains the Apakwa

Vrana sopha.• When the patient does Ahit ahara and

vihara.• Bhagna vrana upeksha- vrana created

by Bhagna treated improperly.

ETIOLOGY

CLASSIFICATION

• Vataja• Pittaja • Kaphaja• Vata-Pittaja• Pitta-Kaphja• Vata- Kaphja• Sannipataja• Shalyaja

PILONIDAL SINUSIN

AYURVEDA

• Bala (hair) shalya is one among in different types of shalyas

• The main cause of this sinus is hairs

• Here Pilonidal sinus can be considered under the classification of shalyaja nadi vrana

PILUS = Hair; NIDUS = Nest

means ‘ Nest of hair’

Cross section of P.Sinus

SITES

• Finger webs of barber.

• Axilla.

• Mid thigh amputation stump.

• Umbilicus

• Supra pubic region.

• Post anal region

DIRECTIONS OF SPREADING

CLINICAL FEATURES

• A symptomatic

• Chronic sepsis

• Acute Abscess

DIFFERENTIAL DIAGNOSIS

• Hidradenitis suppurative

• Fistula- in-Ano

COMPLICATIONS

• Most common complication is acute and chronic infections.

• Malignant degeneration rarely occurs in pilonidal disease, although verrucous carcinoma (giant condyloma acuminatum) has been described.

Materials:

-Gauze-Scissors-Measuring scale-Slough cutter-Pratisarneeyakshara-(Apamrga kshara)-Surgical pads-Probing needles-Artery forceps

-Sinus forceps-Scalpel-Gloves-Kidney tray-Nimbu swarasa

SOURCE OF DATA

Patients were randomly selected from OPD and IPD of SDM College of Ayurveda and Hospital after the diagnosis.

MANAGEMENT

The treatment of pilonidal sinus can be divided as:

1. Emergency treatment - For abscess

2. Elective Treatment

3. Radical excision

- This treatment consist of Conservative Surgery which include.

- Excision of midline pits and clearing the tracts

- Follicle Removal

- Phenol Injection

- Lying Open Tracks

2. Elective Treatment

3. Radical excision

• Excision and Healing by granulation• Excision and Marsupialization• Excision and Primary closure• Closure by z- Plasty• Resuture the Rhomboid Flap• Myocutaneous Flap and Other Procedures

• Excision and split Skin grafting

• The treatment of Nadi Vrana can be performed by following methods:

• Surgical technique - Uthpatana karma.

• Para-surgical technique – Anusastra karma.

• Medical technique – Anushadha karma.

SAMANYA CHIKITSA OF NADI VRANA

The above upakrama can be performed in three stages

• Pre operative

• Operative

• Post operative

PRE OPERATIVE

1. Pre operative check up check up was done to rule out any systemic disorder like diabetes etc

2. Pre operative anesthetic check.

3. Nil by mouth six hours before surgery.

4. Part preparation

5. Soap water enema

6. Inj. T.T

OPERATIVE

1. Patient was made to lie down in left lateral position.

2. Painting was done with betadiene and spirit.

3. Draping done.

4. Probing is done to see the length of the tract

5.With the help of scalpel an elliptical incision is made around the post anal sinus.

6.The whole sinus tract will be excised deep up to the presacral fascia.

7.During the whole surgical process the haemostasis will be maintained.

8. After Application of the Apamarga

pratisarneeya kshara over wound.

Condition of the wound during the application of the Kshara

Condition of the wound Immediately after application of the Kshara

Excised sinus

End of the surgery

POST OPERATIVE:

1. Daily dressing will be done.

2. Weekly shaving will be done to the post anal area.

CONCLUSIONPilonidal sinus can be considered as a shalyaja nadi vrana

The application of the pratisarana kshara curettes the lateral sinus and avoids the recurrence.

Compared to the other parallel treatment procedures,the above said procedure proved to be effective in the therapeutic and recurrence aspect.