KSHARA SUTRA IN THE MANAGEMENT OF INTERSPHINCTERIC BHAGANDARA (PERIANAL FISTULA-IN-ANO): A CASE REPORT

Abstract

Bhagandara (fistula-in-ano) is regarded by Acharya Sushruta as difficult to manage, owing to its chronic, recurrent, discharging nature. Kshara Sutra, a medicated thread prepared with Snuhi Ksheera, Apamarga Kshara and Haridra churna, combines Kshara Karma (chemical cauterisation), Ksharana (debridement) and Chedana (slow mechanical cutting), and remains a validated surgical modality for fistula management. In this case study, we discuss a 25-year-old male with recurrent mucopurulent perianal discharge, diagnosed by fistulogram imaging as an active intersphincteric left perianal fistula (Grade 1, St James's University Hospital classification) with a tract measuring 4.4 mm in calibre and 38 mm in length. He was managed with a Kshara Sutra standardised by the Central Council for Research in Ayurvedic Sciences (CCRAS) and prepared over Barbour's linen thread No. 20, changed weekly under Triphala Kwatha Parisheka and oral Ayurvedic medication (Saptavimshati Guggulu, Gandhak Rasayan, Arogyavardhini Vati and Abhayarishta). Complete tract transection was achieved over eight ligations, at an average Unit Cutting Time (UCT) of approximately 14.7 days/cm (4.75 mm per week), and the wound healed fully without recurrence or incontinence at three-month follow-up. This case reaffirms Kshara Sutra as a safe, sphincter-preserving, cost-effective alternative for intersphincteric fistula-in-ano.