A Dual Modality Approach in Treating Fistula-in-Ano With Ksharasutra and Surgical Intervention: A Case Report

Background: Bhagandara described in Ayurveda correlates with fistula-in-ano and is considered a Kruchrasadhya Vyadhi due to its chronic and recurrent nature. Ksharasutra therapy is an established Ayurvedic para-surgical procedure. In selected cases, a combined surgical and Ksharasutra approach may improve outcomes. Case Presentation: A 50-year-old male presented with pain and foul-smelling pus discharge from the anal canal and left perianal region for 15 days. Pain was throbbing, aggravated by prolonged sitting, and partially relieved after pus discharge. The patient was a known case of diabetes mellitus. Local examination revealed an external opening at the left scrotal base and an internal opening at the 2 o’clock position. Endoanal ultrasonography showed a broad fistulous tract extending to the anterolateral anal wall. Diagnosis: Based on clinical features, imaging findings, and Ayurvedic assessment, the condition was diagnosed as Parishravi Bhagandara (fistula-in-ano). Intervention: Under spinal anesthesia, fistulotomy followed by primary threading was performed. Ksharasutra was changed weekly with appropriate post-operative care. Outcome: The patient showed marked reduction in pain and discharge with progressive healing of the tract and no complications. Conclusion: The dual modality approach with Partial fistulotomy followed by Ksharasutra therapy is a safe, effective, and sphincter‑preserving approach for the management of Parisravi Bhagandara, particularly in trans‑sphincteric fistula‑in‑ano.