Ksharasutra therapy, a medicated thread technique described in the Indian system of medicine, is widely utilized in the management of anorectal disorders, especially Bhagandara (fistula-in-ano). In the present case, a Guggulu-based Ksharasutra was prepared in accordance with the standards of the Ayurvedic Pharmacopeia of India, using Apamarga Kshara (derived from Achyranthes aspera), Guggulu (Commiphora mukul), and Haridra (Curcuma longa). A patient diagnosed with a low trans-sphincteric fistula located in the anterior region of the anal canal was managed through a combined approach of partial fistulectomy followed by application of Guggulu-based Ksharasutra in the residual tract. The Ksharasutra was replaced at weekly intervals using the railroad technique. The length of the tract was recorded regularly to evaluate the unit cutting time (UCT). Postoperative wound care was carried out with daily dressing using Shatadhauta Ghrita. Throughout the treatment period, the patient was able to continue routine daily activities without significant discomfort. Complete transection of the fistulous tract was achieved within two months, with eight Ksharasutra changes. The surgical wound healed satisfactorily, resulting in a healthy scar and no observed complications. This case highlights the effectiveness of combining partial fistulectomy with Guggulu- based Ksharasutra therapy in the management of fistula-in-ano, demonstrating comparatively faster healing than Ksharasutra therapy alone.
2Dr. Subhendu Bikash Sahu 1*Dr. Ranjeet Kumar Sahu (Mon,) studied this question.