Analysis of Ksharsutra the healing thread for fistula-in-ano.
Fistula in ano is a disease, which has been included in the ashta mahagad by acharya sushruta. Even today when the modern surgery is at its peek, fistula in ano is still a challenge to the surgeons for its incidence of recurrence & Postoperative complications.

The method devised by ancient acharyas to treat this disease is the only fool proof method available to cure fistula-in-ano.


Kshara-sutra is a medicated thread which is prepared by applying the coatings of apamarg kshara, haridra churna etc. with snuhi ksheer as binding agent. The thread is then sterilized by U V Radiation. The cumulative effect of the above-mentioned three drugs exerts a powerful debridement effect on the fistula tract & induces healing by the fresh & healthy granulation tissues. The sutra is the mechanism of drug delivery precisely at the tissues involved.


The patient is routinely investigated with special reference to any other associated disorder like hypertension diabetes mellitus, tuberculosis etc. The next step lies In the proper identification & evaluation of the fistulous tract. This is achieved by careful probing with malleable probes.

However USG or fistulogram may be required in the cases like high anal fistula, recurrent fistula, fistula with multiple openings & branching pattern. Once the tract has been accurately defined, it has to be ligated with kshara-sutra, as an OPD procedure. Every seventh day the old sutra is replaced with a new KS till there is a finale cut through.

It has been observed that the length of the tract reduces @ 0.5-1 cm per week, but then there are several factors which modify this cutting rate of the thread e.g. in the patient of post surgical recurrence, there is abundance of fibrous tissue which reduces the cutting rate.


Kshara sutra is the novel idea of drug delivery along the whole length of the fistulous tract by the ayurvedic surgeons.

During kshar-sutra therapy there is debridement & cutting of the tissues followed by healing.

The kshara acts as powerful debriding agent & selectively acts on the unhealthy tissues, pus pockets etc.

This process of debridement & healing starts from deeper tissues & travels towards periphery in stages.

The postoperative complications like recurrence of the disease, fecal incontinence, bleeding is not seen with kshara sutra treatment. Further this therapy is performed as an OPD procedure.

No general anesthesia & no hospitalization is required.

Patient maintains his normal routine activities as usual during treatment period.

	Other indications of Ksharasutra
	Hemorrhoids Anal fissures Chronic discharging sinuses with osteomyelitis Pilonidal sinuses Non healing wounds Milk fistula Tubercular sinuses Genital warts

	Other methods of application of Kshara
	Kshara varti Kshara pitchu Kshar pratisaran

Ayurveda specialist offers beter cure rates for fistula in ano as compared to modern surgeons.

The incidence of anorectal diseases is increasing day by day due to fast food culture, Low fibrediet, sedentary life style etc. Most of these diseases are treated surgically, which is usually associated with Post operative pain, bleeding, decrease in sphincter strength & some times recurrence of the disease. After extensive research using ayurvedic treatment methodologies with modern equipments & technology certain treatment modalities have been formulated. These methods are non surgical or parasurgical hence more convenient & have better results as compared to modern surgery in certain diseases.

Sushruta surgical center is a pioneer center for treating ano-rectal Diseases ie. Fistula, piles, fissure etc using graded Kshar sutra therapy-a concept of Ayurvedic surgery. The technique has been scientifically developed & clinically evaluated. Indian Council Of Medical Research, the apex body of medical research in India has conducted clinical trials of kshar sutra therapy in the disease FISTULA-IN-ANO, at four centers including AIIMS.

The results of this clinical trial have been officially released. It has been proved that ksharsutra is more effective & more suitable treatment as compared to surgery for treating fistula in ano.

Surgeons & medical practioners who are aware of this research are referring the patients of fistula-in-ano to our center.


Dr. S.K. Singh M.S. (Ayurveda) Gold Medalist (B. H. U.)
Member-National Academy of Ayurveda, Govt. of India
Ex. Senior ano-rectal (ayurveda) specialist MOOLCHAND HOSPITAL, DELHI
Ex. Senior kshar sutra specialist-mahirishi ayurvedaarogyadham Delhi, India