{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T21:12:43Z","timestamp":1778188363287,"version":"3.51.4"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"C","license":[{"start":{"date-parts":[[2024,10,1]],"date-time":"2024-10-01T00:00:00Z","timestamp":1727740800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2024,10,1]],"date-time":"2024-10-01T00:00:00Z","timestamp":1727740800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2024,9,6]],"date-time":"2024-09-06T00:00:00Z","timestamp":1725580800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Fistula in ano is a complex disease, and the treatment for it is still a big challenge for surgeons because of the high recurrence rate (7 %-50 %) and incontinence, and to minimize these complications numerous surgical interventions are emerging daily in the conventional system of medicine.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Presentation of case:<\/jats:title>\n                    <jats:p>\n                      A 48- year- old male patient came with complaints of pus discharge from an external opening in the inner aspect of his right thigh, located about 22 to 25 cm away from the anal verge for the last 15 years and was diagnosed as long extrasphincteric fistula with intrarectal opening based on clinical and MRI findings. We successfully treated this case with a minimally invasive novel surgical technique,\n                      <jats:bold>R<\/jats:bold>\n                      etro\n                      <jats:bold>G<\/jats:bold>\n                      rade\n                      <jats:bold>P<\/jats:bold>\n                      robing and\n                      <jats:bold>A<\/jats:bold>\n                      pplication of\n                      <jats:bold>K<\/jats:bold>\n                      hara\n                      <jats:bold>S<\/jats:bold>\n                      utra and\n                      <jats:bold>D<\/jats:bold>\n                      ivision of the\n                      <jats:bold>F<\/jats:bold>\n                      istulous\n                      <jats:bold>T<\/jats:bold>\n                      ract (RGPAKS- DFT).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion:<\/jats:title>\n                    <jats:p>Ksharasutra is a well-known method in the treatment of anal fistula for preserving continence and a low recurrence rate. Performing retrograde probing in every single case of anal fistula can address the involved anal gland under direct vision, which is essential for preventing recurrence and pairing retrograde probing with the division of the fistulous tract significantly reduces the treatment duration with minimal tissue loss.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>In fistula surgery, successful treatment relies on identifying the internal opening and eradicating the involved anal glands. Based on the same principle, this rare and complex anal fistula was effectively treated with this RGPAKS-DFT, resulting in no recurrence and incontinence in two years of follow-up after complete recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Highlights<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1016\/j.ijscr.2024.110259","type":"journal-article","created":{"date-parts":[[2024,9,7]],"date-time":"2024-09-07T04:40:05Z","timestamp":1725684005000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Extrasphincteric anal fistula with intrarectal opening extended upto thigh, successfully treated with a minimally invasive, novel surgical technique- a rare case report"],"prefix":"10.1097","volume":"123","author":[{"given":"Swapna","family":"Bopparathi","sequence":"first","affiliation":[{"name":"Associate Professor, Department of Shalya Tantra, National Institute of Ayurveda, Deemed to be University, Amer Road, Jaipur, Rajasthan, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Narasimha Raju","family":"K.V","sequence":"additional","affiliation":[{"name":"Former Head and Professor, Dept. of Kaya Chikitsa, Faculty of Ayurvedic Sciences, Jayoti Vidyapeeth Women's University, Jaipur, Rajasthan, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"issue":"1","key":"R2-86-20260507","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1055\/s-0035-1570392","article-title":"Management of complex anal fistulas","volume":"29","author":"Bubbers,","year":"2016","journal-title":"Clin. Colon Rectal Surg."},{"issue":"12","key":"R3-86-20260507","first-page":"1370","article-title":"Clinical characteristics and risk factors for recurrence of anal fistula patients Zhonghua wei chang Wai ke za zhi","volume":"19","author":"Li,","year":"2016","journal-title":"Chin. J. Gastrointes. Surg."},{"issue":"7","key":"R4-86-20260507","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1007\/BF02054434","article-title":"Anal fistula surgery. Factors associated with recurrence and incontinence","volume":"39","author":"Garcia-Aguilar,","year":"1996","journal-title":"Dis. Colon Rectum"},{"issue":"28","key":"R5-86-20260507","doi-asserted-by":"crossref","first-page":"3292","DOI":"10.3748\/wjg.v17.i28.3292","article-title":"Why do we have so much trouble treating anal fistula?","volume":"17","author":"Dudukgian,","year":"2011","journal-title":"World J. Gastroenterol."},{"issue":"2","key":"R9-86-20260507","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/0378-8741(90)90056-Y","article-title":"Analysis of a thread used in the Kshara sutra treatment in the Ayurvedic medicinal system","volume":"29","author":"Gewali,","year":"1990","journal-title":"J. Ethnopharmacol."},{"key":"R10-86-20260507","first-page":"177","article-title":"Multicentric randomized controlled clinical trial of Kshaarasootra (Ayurvedic medicated thread) in the management of fistula-in-ano. Indian Council of Medical Research","volume":"94","year":"1991","journal-title":"Indian J. Med. Res."},{"issue":"1","key":"R11-86-20260507","first-page":"6","article-title":"Efficacy of Kshar sutra (medicated seton) therapy in the management of fistula-in-Ano","volume":"2","author":"Srivastava,","year":"2010","journal-title":"World J. Colorec Sur."},{"issue":"1","key":"R12-86-20260507","first-page":"53","article-title":"Recurrence pattern of fistula-in-ano in a Chinese population","volume":"17","author":"Poon,","year":"2008","journal-title":"J. Gastrointestin. Liver Dis."},{"issue":"2","key":"R13-86-20260507","first-page":"169","article-title":"Fistula-in-ano. Clinical features and long-term results of surgery in 199 adults","volume":"151","author":"Sainio,","year":"1985","journal-title":"Acta Chir. Scand."},{"issue":"28","key":"R14-86-20260507","doi-asserted-by":"crossref","first-page":"3272","DOI":"10.3748\/wjg.v17.i28.3272","article-title":"Anal fistula: intraoperative difficulties and unexpected findings","volume":"17","author":"Abou-Zeid,","year":"2011","journal-title":"World J. Gastroenterol."},{"issue":"5","key":"R15-86-20260507","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1097\/JS9.0000000000000373","article-title":"The SCARE 2023 guideline: updating consensus surgical CAse REport (SCARE) guidelines","volume":"109","author":"Sohrabi,","year":"2023","journal-title":"Int. J. Surg. Lond. Engl."},{"issue":"1","key":"R16-86-20260507","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1002\/bjs.1800630102","article-title":"A classification of fistula-in-ano","volume":"63","author":"Parks,","year":"1976","journal-title":"Br. J. Surg."},{"issue":"1","key":"R17-86-20260507","first-page":"56","article-title":"Classic articles in colon and rectal surgery. Hippocrates: on fistulae","volume":"23","author":"Corman,","year":"1980","journal-title":"Dis. Colon Rectum"},{"issue":"3","key":"R18-86-20260507","first-page":"197","article-title":"Classic articles in colonic and rectal surgery. John Arderne 1307-1380(?). Treatises of fistula in Ano","volume":"26","year":"1983","journal-title":"Dis. Colon Rectum"},{"issue":"4","key":"R19-86-20260507","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1007\/s12262-017-1668-1","article-title":"The easiest way to insert Ksharsutra with the help of an infant feeding tube instead of a metallic probe. The","volume":"79","author":"Kumar,","year":"2017","journal-title":"Indian J. Surg."},{"issue":"1","key":"R20-86-20260507","first-page":"49","article-title":"Treatment of fistula-in-ano by a new technique. Review and follow-up of 200 cases","volume":"24","author":"Deshpande,","year":"1973","journal-title":"Am. J. 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