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Kshara Sutra therapy is a minimal invasive Ayurvedic Parasurgical procedure and time-tested Ayurvedic technique in the management of Anorectal disorders. It is a safe, sure and cost-effective method of treatment for fistula-in-ano, hemorrhoids and other sinus diseases. Though the therapy has been described in Ayurveda by Sushruta, Charak, and Vagbhata but the efficacy of this therapy was re-established by the Dept. of Shalya Tantra, Banaras Hindu University and later period revalidated by scientific organizations like CCRAS and ICMR. This technique is being practiced widely in our country and in some other countries. The Standard Kshara Sutra is prepared by 11 coatings of Snuhi latex (Euphorbia nerifolia), 7 coatings of Snuhi latex and Apamarga Kshara (Achyranthes aspera) and last 3 coatings of Snuhi latex and Haridra Churna (Curcuma longum). The pH of Apamarga Kshara Sutra is 9.72. The patient is anesthetized with local or spinal or general anesthesia, then a malleable probe is passed through the external opening of the fistula to the internal opening in the anal canal and probe is gently taken out through anal opening to the outside along with a Kshara Sutra in the groove of the probe. Later both ends of the Kshara Sutra is tied together. The Kshara Sutra is replaced by a new one after an interval of one week. The Kshara Sutra gradually cuts and heals the tract. Finally, the whole fistulous tract heals after cutting.
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