“KSHARASUTRA THERAPY IN FISTULA-IN-ANO: CLASSICAL DESCRIPTION AND CURRENT CLINICAL RESEARCH”
Introduction: Fistula-in-ano is a chronic and recurrent anorectal disorder with significant morbidity and a high rate of recurrence following conventional surgical interventions. Ayurveda, through the works of Sushruta Samhita, describes Ksharasutra therapy as a unique para-surgical technique for the effective management of Bhagandara (fistula-in-ano). Methods: A comprehensive literature review was conducted using Ayurvedic classical texts, commentaries, and modern scientific databases including PubMed, Scopus, and Web of Science. Search terms included “Ksharasutra,” “fistula-in-ano,” “Ayurveda,” “surgical thread therapy,” and “para-surgical procedures.” Randomized controlled trials, observational studies, meta-analyses, and case series from the last two decades were included. Exclusion criteria were non-peer-reviewed articles, animal studies, and reports with incomplete outcome data. Results: Classical Ayurvedic texts describe Ksharasutra as a medicated thread coated with herbal alkalis (e.g., Apamarga Kshara), latex (Snuhi ksheera), and turmeric (Haridra), providing mechanical pressure, chemical cauterization, and antimicrobial action. Clinical studies show that Ksharasutra therapy offers high success rates (85–95%), lower recurrence (5–7%), and minimal complications compared to conventional surgical approaches. Randomized controlled trials confirm shorter hospital stays, cost-effectiveness, and patient satisfaction. Innovations such as modified Ksharasutra and adjunctive wound healing agents have further optimized outcomes. Discussion: While modern surgery often faces challenges of recurrence, incontinence, and delayed healing, Ksharasutra offers a holistic approach addressing local pathology and systemic balance. However, limitations include procedure-related pain, the need for multiple sittings, and lack of large multicenter randomized trials. Future directions involve standardization of preparation, global acceptance, and integration with modern surgical protocols. Conclusion: Ksharasutra therapy represents a time-tested, effective, and safe modality for fistula-in-ano management, blending ancient Ayurvedic wisdom with modern clinical validation. Its integration into contemporary practice may offer a sustainable and patient-friendly alternative to conventional surgery.
KEYWORDS: Ayurveda, Bhagandara, fistula-in-ano, Ksharasutra, para-surgical therapy