PILONIDAL SINUS: KSHARA SUTRA AND MINIMALLY INVASIVE APPROACHES IN THE LIGHT OF MODERN MANAGEMENT
Background: Pilonidal sinus disease is a chronic inflammatory condition of the sacrococcygeal region that mainly affects young adults. Conventional excision surgery often involves long healing times, prolonged absence from work and high recurrence rates. Ayurveda describes chronic sinuses as Nadi Vrana and treats them with Kshara Sutra, a medicated seton that gradually cuts and heals the tract. Objective: To review the modern understanding and management of pilonidal sinus, the classical basis of Kshara Sutra in Nadi Vrana, and the evidence for Kshara Sutra and other minimally invasive approaches. Methods: Narrative review of Sushruta Samhita, surgical guidelines, meta-analyses, Cochrane reviews and clinical reports. Results: Pilonidal disease is now understood as an acquired condition caused by penetration of loose hairs into the skin of the natal cleft. Treatment options include excision with open healing or midline closure, off-midline flap procedures, and minimally invasive approaches such as pit picking, phenol injection and endoscopic treatment. A large meta-analysis found substantial differences in recurrence between procedures, with off-midline techniques performing better than midline closure. Sushruta recommends Kshara Sutra for sinuses in patients who are weak, fearful or at delicate sites. Case reports and a small case series of Kshara Sutra in pilonidal sinus reported healing in about four weeks with no recurrence over follow-up. Conclusion: Kshara Sutra is a promising minimally invasive option for selected pilonidal sinuses, particularly simple tracts. Evidence is limited to case reports and small series; comparative trials against modern minimally invasive techniques are needed.
KEYWORDS: pilonidal sinus; Nadi Vrana; Kshara Sutra; minimally invasive surgery; pit picking; recurrence