A Case Study on the Clinical Effectiveness of Tilanala Ksharasutra in Bhagandara With Special Reference to Fistula-in-Ano

Background: Bhagandara (Fistula-in-Ano) is a complex anorectal disorder marked by an abnormal tract between the anal canal and perianal skin, often associated with pain, discharge, and recurrence. Conventional management typically involves surgical intervention, which may be associated with postoperative complications and recurrence. Tilanala Ksharasutra, a specialized Ayurvedic para-surgical modality, is considered a minimally invasive alternative for the management of this condition. Objective: To assess the clinical effectiveness of Tilanala Ksharasutra in the management of Bhagandara (Fistula-in-Ano) with reference to symptom relief, tract healing, and overall patient outcome. Case Presentation: A 35-year-old male patient clinically diagnosed with Bhagandara presented with complaints of persistent pain, swelling, and purulent discharge in the perianal region. The patient was managed with Tilanala Ksharasutra therapy, wherein a medicated thread coated with herbal and alkaline formulations was inserted into the fistulous tract. Methods: The Tilanala Ksharasutra was placed in the tract and changed at regular intervals over a treatment duration of eight weeks. Periodic clinical evaluations were carried out to observe the progress of healing, reduction in symptoms, and any potential adverse reactions. Results: Marked clinical improvement was observed following Tilanala Ksharasutra therapy. There was a substantial reduction in pain, discharge, and local inflammation, with gradual cutting and healing of the tract. Complete healing and closure of the fistulous tract were achieved by the end of the treatment period. The patient experienced minimal discomfort and no recurrence was noted during the follow-up. Conclusion: Tilanala Ksharasutra therapy proved to be an effective, safe, and minimally invasive modality in the management of Bhagandara (Fistula-in-Ano). The positive clinical outcomes indicate that this Ayurvedic para-surgical technique can serve as a reliable alternative to conventional surgical procedures, ensuring effective healing with better patient compliance and reduced recurrence.