Kshara Sutra - The Ayurvedic Miracle treatment for Fistula in ano
Ksharasutra Treatment is an Ayurvedic Parasurgical Technique. Great Sushruta narrated in his teachings the use of Kshara for cure of fistula in ano and other anorectal diseases.In this technique, a specially prepared thread (Kshar Sutra) is used to cure diseases. Kshar Sutra acts by "Herbal Chemical Cauterisation" and removes the disease from the body.

The ano-rectal disorders and their management has established a separate surgico-dynamic  speciality among the various surgical disorders. The ano-rectal disorders have been known form the very early period of evolution to the medical science. The disease Bhagandara (Fistula-in-Ano) is said to have existed about four thousand years according to Wilson (1963) as mentioned by Khurana et al (1972). Furstenbergh et al (1964) have mentioned the method of Apolinose by which Hippocratus, the Father of modern medicine (460 BC) treated Fistula-in-Ano.

The main limitation of treatment of Fistula-in-Ano by conventional surgery is that even after surgical excision of the tract the recurrence rate still remains between 20-30%. Hence this disease even today stands as a challenge in front of the medical world.

Susruta’s method of thread treatment is known as Kshara-sutra treatment as mentioned above and even today it is quite successful method in treating this difficult disease.

Kshara Sutra:
Requirements:
  1. Thread : Surgical Linen thread of size 20.
  2. Latex of Euphorbia neriifolia
  3. Haridra (Curcuma longa)
  4. Apamarg Kshar (Achyranthus aspera).
How to prepare ?
For the preparation of thread, surgical linen thread gauge number 20 was manually coated eleven times with the latex of Euphorbia neriifolia, followed by seven coatings of the latex and the alkaline powder of Achyranthus aspera alternatively, and dried. In the final phase, three coatings of latex and powder of Curcuma longa were given alternatively.

The thread thus prepared was sterilized by ultra violet radiation and placed in a polythene bag or glass tube.

How Kshara Sutra works:
  1. Kshara Sutra tied in the fistulous tract.
  2. Presence of Kshara Sutra in the fistulous tract does not allow the cavity to close down from either ends and there is a continuous drainage of pus.
  3. Kshara Sutra, slowly and gradually cuts the fistulous tract. Also simultaneous cutting and healing of the tract and no pocket of pus is allowed to stay back.
  4. Kshara (Caustics) applied on the thread are - anti-inflammatory, antislough agents and in addition, have property of chemical curetting. It sloughs out the epithelial lining, thereby allowing the fistulous tract to collapse and heal.
  5. Kshara Sutra, due to its antibacterial property, does not allow bacteria to multiply in its presence.
Pre Kshara sutra (Pre-operative):                                                   
  • Should be admitted in the hospital a day before operation.
  •  Laxative is given at previous night
  •  Part preparation done.
  •  Patient is kept fasting for at least 8 hours
  •  Consent form
  •  Enema 2-4 hours before the procedure.
Kshara sutra threading procedure (Operative procedure):
  • The patient is made in Lithotomy position.
  • The perianal area is cleaned by Betadine painting.
  • Digital examination done to locate any induration, internal opening and to exclude other lesions.
  • Probing is done through a malleable probe to locate the internal opening with the index finger of other hand inside the anus. If internal opening is located, the probe is pushed out through the anal verge and the track is threaded loosely by Kshara sutra. However if internal opening couldn’t be located it is made inside the anal canal at a point which offer least resistance to the tip of the probe. Again Kshara sutra threading of the track is done loosely.
  • 10 ml. of Jatyadi oil is pushed inside the rectum and sterilized gauze is applied on the anus covering the external opening.
  • T-bandage is tied to keep the dressing in proper position.
  • Thereafter the patient is shifted to the ward.
Advices after Treatment:
Patients are advised strictly:-
  1. To take normal food daily and avoid irritant spicy food.
  2. To take fibre containing diet & vegetables with plenty of water.
  3. To avoid such types of foods which cause constipation.
  4. To keep the bowel clear regularly by taking suitable and mild laxatives.
  5. To avoid prolonged sitting as well as standing during the treatment.
  6. To avoid long distance travelling and driving.
  7. To keep the anal region clean and do proper dressing.
Benefits of the Ksharasutra Therapy:
  1. It is an Out Patient Treatment.
  2. Performed mostly under Local anesthesia.
  3. Only 30- 45 minutes is required for the procedure
  4. Hospital stay is usually minimum (5-6 hrs).
  5. Minimal bed rest is required after the procedure.
  6. Patient can resume his / her daily routine within 3 to 5 days.
  7. The recurrence rate is very less after Ksharasutra ligation procedure
  8. Most important benefit of Kshara Sutra Therapy over Modern Surgeries is that the muscles that supports the Anus and helps in controlling the bowel movements are not dissected and hence the possibility of Anal Incontinence (loss of power to hold stools) is not there.
NOTE: The procedure can also be performed under local anaesthesia or without anaesthesia at all if the patient is co-operative.

Author: Dr.Thushar Babu BAMS, M.S(Ayu)
I am Dr.Thushar Babu MS (Ayu) ,currently Practicing Ayurvedic management for various disease Spine disorders, Varicose veins and all types of ano-rectal disorders. Now working as an Ayurvedic Surgeon at Mandaram Ayurveda Wellness center.

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