General Surgery & Proctology

Overview

Proctology is the treatment of conditions of the colon, rectum and anal canal. It is the principal practice of this department, not a sideline — and it is the reason most patients come to this hospital.

Our approach is to combine Ayurvedic para-surgical technique with conventional surgery and use whichever genuinely suits the case, rather than treating everything one way. Much ano-rectal disease does not need an operation at all: with the right medication, diet and local treatment, we have avoided surgery in more than 10,000 patients. Where a procedure is needed, Kshara Sutra and Kshara Karma are usually the better option, and conventional surgery remains available when it is not.

Conditions we treat

Each of these has its own page covering symptoms, grades, treatment options and recovery in detail:

• Piles (haemorrhoids) — bleeding, prolapse and the grades that decide whether a procedure is needed at all
• Anal fistula — a tract that will not heal on its own, and the condition Kshara Sutra treats best
• Anal fissure — the sharp pain after passing stool that is very often mistaken for piles
• Pilonidal sinus — recurrent discharge at the top of the buttock cleft, notorious for coming back after wide excision

Also treated: anal abscess, warts and skin tags, rectal and anal polyps, chronic constipation, and general surgical conditions of the abdomen, skin and soft tissue.

Kshara Sutra and Kshara Karma — which is which

These two get confused constantly, including by people who have already been told they need one of them. The difference is simply what is being treated:

	Kshara Sutra	Kshara Karma
Treats	Tracts — fistula, pilonidal sinus	Masses — piles, warts, polyps
How	A medicated thread threaded through the tract, changed weekly	Alkaline preparation applied directly to the mass
Duration	Weeks to months, depending on the tract	Usually a small number of sittings
Setting	Day-care procedure, then weekly outpatient visits	Outpatient

Both divide or shrink tissue gradually rather than cutting it in one action, which is what keeps the anal sphincter — and continence — intact. Full detail on the technique is on the Kshara Sutra page.

Cost

Para-surgical sessions are ₹2,500 to ₹6,000 each.

There is no single fixed price, because the number of sittings is what decides the total and that depends on what the examination finds. A simple low fistula usually needs roughly 4 to 6 weekly sessions; a long or branching tract needs considerably more. First- and second-degree piles often need no procedure at all.

You get a written estimate covering the whole course at your first consultation, before anything is scheduled. Conventional surgery is quoted separately.

When to come in

Ano-rectal symptoms are embarrassing and most people wait far too long. Two things worth knowing:

• Bleeding is never something to watch and wait on. It is usually piles or a fissure, but it is also how bowel cancer presents, and only an examination separates them. Nobody has ever been wrong to get it checked.
• A fistula will not heal by itself. Antibiotics settle the flare; the tract stays. Treated early it is usually a simple, short course. Left for years it branches, and then it is neither.

Examination takes a few minutes and is done with the same discretion as any other consultation.

Who treats you

Dr Neelambika G. B. — BAMS, MS (Ayurveda), PhD — leads this department, with 18+ years in proctology and ano-rectal work as her principal practice rather than an occasional case. She is supported by Dr Kishor Kumar Hullatti in general and para-surgical work.

Outcomes in Kshara Sutra depend heavily on the operator: the preparation of the thread, the judgement in mapping the tract, and the handling of each weekly change. How often a centre does this work is a fair thing to ask, and worth asking anywhere you consider.