Ksharsutra Therapy in Fistula-in-Ano: A Review

Abstract

Background:
Fistula-in-Ano is a common yet challenging anorectal condition characterized by the formation of an abnormal tract between the anal canal and perianal skin, often resulting from cryptoglandular infection. Conventional surgical treatments such as fistulectomy and fistulotomy are associated with high recurrence rates, postoperative complications, and potential damage to the anal sphincter, leading to incontinence.

Objective:

This review aims to explore the efficacy, methodology, and clinical advantages of the Ayurvedic technique of Ksharasutra therapy as a minimally invasive, sphincter-preserving alternative for the management of fistula-in-Ano.

Methods:
The preparation of Ksharasutra involves coating a surgical linen thread with a combination of Snuhi latex (Euphorbia neriifolia), Apamarga Kshara (Achyranthes aspera), and Haridra (Curcuma longa) in 21 layers, providing sustained caustic, antimicrobial, and healing properties. The therapy is performed on an outpatient basis, with weekly thread changes and progressive transection of the tract.

Results:

Clinical outcomes have demonstrated near 100% cure rates in both primary and recurrent fistula cases, with minimal recurrence (<5%), preserved anal sphincter function, and reduced risk of incontinence. Ksharasutra therapy is particularly safe for patients with comorbidities such as diabetes and hypertension and has shown promising results in treating other chronic sinus conditions including pilonidal sinus, preauricular sinus, and osteomyelitic sinuses.

Conclusion:

Ksharasutra therapy offers a safe, cost-effective, and highly efficacious alternative to conventional surgery for fistula-in-Ano. Its ability to simultaneously cut and heal the tract, preserve sphincter function, and avoid hospitalization makes it an ideal treatment modality, especially in resource-limited or rural healthcare settings. Further integration with modern diagnostic tools and clinical research can enhance its global acceptance.

KEYWORDS: Ksharasutra therapy, Fistula-in-Ano, Ayurveda, Apamarga Kshara, Snuhi latex, Haridra