Ksharasutra Therapy in the Management of Recurrent Trans-Sphincteric Fistula-in-Ano

Abstract

Bhagandara, which may be clinically correlated with fistula-in-ano, is a chronic and recurrent anorectal disorder. Recurrent trans-sphincteric fistula-in-ano following previous surgery presents a therapeutic challenge because repeated procedures may increase the risk of sphincter injury and recurrence. This case study describes a 54-year-old male with recurrent fistula-in-ano after two previous fistulectomy procedures. Magnetic resonance imaging demonstrated a recurrent left-sided fistulous tract with an internal opening at the 6 o’clock position. Ksharasutra ligation was performed under local anaesthesia, followed by weekly replacement, local wound care and adjuvant Ayurvedic treatment. Eight weekly Ksharasutra changes were completed over approximately two months, resulting in progressive cutting and healing of the fistulous tract. Following complete cut-through, the residual wound was managed with Karanja Taila and healed within approximately seven days. Pain, pus discharge and perianal swelling resolved, while anal continence was preserved. At the final documented follow-up, the patient became symptom-free with no clinical evidence of recurrence. This case suggests that Ksharasutra therapy can be considered for selected recurrent fistula-in-ano cases after previous surgery.