Anal fistula treatment with ksharasutra: The Ayurvedic surgical technique for Anal Fistula

Anal fistula, known as Bhagandara in Ayurveda, is a painful and notoriously recurrent anorectal condition. For decades, patients seeking a definitive, yet less invasive cure have turned to Ksharasutra therapy. This specialized Ayurvedic procedure is hailed as a gold-standard treatment, offering high success rates while preserving anal function, a critical factor often compromised by conventional surgeries.

The Unmatched Merits of Anal fistula treatment with ksharasutra

Ksharasutra therapy is a minimally invasive technique that uses a medicated seton (thread) to treat the fistula tract. Its advantages, particularly when compared to conventional surgery like fistulotomy or fistulectomy, are compelling and contribute to its high rate of success:

• Minimal Invasiveness: The procedure involves threading the medicated seton through the fistula tract, avoiding deep cuts or extensive surgery. This reduces trauma to the surrounding tissues and results in less blood loss.

• Preservation of Anal Sphincter: This is arguably the most significant merit. Unlike many surgical procedures that carry a risk of cutting through the sphincter muscles, potentially leading to anal incontinence (loss of bowel control), the Ksharasutra gradually cuts and heals the tract simultaneously, allowing the sphincter muscles to remain intact and functional.

• Lowest Recurrence Rate: The thread's alkaline and antimicrobial coating continuously medicates the tract. It chemically debrides (cleanses) the unhealthy granulation tissue and fibroses the path from the base upwards. This mechanism ensures complete eradication of the tract, leading to a recurrence rate as low as 4%, which is significantly lower than many conventional surgeries.

  
  

Preparation of Ksharasutra (The Medicated Thread)

The efficacy of the treatment lies entirely in the potent, multi-layered preparation of the thread itself. The standard preparation method is a meticulous, multi-day process involving 21 coatings of three main herbal components:

1. The Base Thread: A surgical linen thread (typically No. 20 size) is selected for its strength and absorbency. It is stretched on a special frame and sterilized, often in a cabinet fitted with a UV lamp.

2. Snuhi Ksheera (Latex of Euphorbia neriifolia): This is the primary coating material. The fresh milky latex is collected and used for the initial 11 layers. Each layer is applied and allowed to dry completely before the next is added. This ingredient acts as a binding agent and has antibacterial properties.

3. Apamarga Kshara (Alkaline Ash of Achyranthes aspera): The thread is coated with Snuhi Ksheera and then rolled in the fine powder of Apamarga Kshara. This process is repeated for the next 7 layers. Apamarga Kshara is the active alkaline component (Kshara) that provides the thread with its cutting and chemical debridement action.

4. Haridra Churna (Turmeric Powder): The final 3 layers involve coating the thread with Snuhi Ksheera and then rolling it in Turmeric powder. Haridra is well-known for its powerful antiseptic, anti-inflammatory, and healing properties, which facilitate clean wound healing.

   
   

The entire process results in a medicated thread that is simultaneously a chedan karma (cutting/debridement) and a dahan karma (cauterizing/healing) agent, capable of clearing the infected tract while promoting the growth of new, healthy tissue.

Anal fistula treatment with ksharasutra is a testament to the sophistication of ancient Ayurvedic minimal invasive surgery. It provides a long-term cure for a complex problem by working locally, progressively, and naturally, making it a highly reliable and patient-friendly treatment choice for anal fistula.