Ksharsutra and Fistula

Fistula in ano is one of the most common diseases of the ano rectal region. Treatment of Fistula in ano has puzzled the medical fraternity due to its complex nature. Commonly prevalent surgical treatment for anal Fistula, that is “Fistulectomy” does not provide successful cure for the disease, post operative complications and recurrences being common. Acharya Sushruta an ancient Indian Surgeon has described in his text ‘ Sushruta Samhita’ about an ancient Ayurvedic technique of medicated thread called Ksharsutra treatment for Bhagandara ( Fistula in ano). Treatment of anal Fistula (Bhagandara)and Nadi-Vrana(Sinus) with Ksharsutra was practiced by Sushruta (1000-600B.C.)

The Kshar Sutra was a standard medicated thread smeared with Kshar of Apamarga (Achyranthus aspera), Shnuhi (Eforbia Nerrifolia) which has quality of cutting and Haridra(Curcuma Longa) which is used as a antiseptic. The ph value of the thread thus prepared was determined and its sterilization effected by ultraviolet radiation. The alkalinity of Kshar Sutra was 9.2ph

Ksharsutra is a popular treatment modality in India for the management of fistula-in-ano. It works by the action of excision, scraping, draining, penetrating, debridement, and sclerosing as well as healing simultaneously without a surgical excision. The conventional method to insert a ksharsutra by using a metallic probe through an external opening may cause pain and discomfort to the patients. In some cases, this intervention is not possible without general anaesthesia. The ksharsutra may be inserted through an external opening by using an infant feeding tube (no. 5 or 6) without causing pain as a day care procedure.