Abstract
Background: Anal fistula is an abnormal track with an external opening in the perianal skin region and internal opening in the modified skin or mucosa of anal canal or rectum. The description of Bhagandara described in Ayurveda can be correlated to anal fistula. Managing of high anal fistula is a very tedious job and fecal incontinence may be developed after surgery due to damage of anorectal ring. Kshara (alkali) work effectively on various stages of a wound and is helpful in treating fistula-in ano. Ksharasutra (alkaline seton) is a type of para surgical procedure described in Ayurveda classics.

Aim: The present review aims at analysing the current trends in the usage of Ksharakarma (alkaline therapy) and Ksharasutra in the management of fistula–in-ano.

Materials & Methods: The present study is a procedural review on techniques of application of Ksharakarma and Ksharasutra employed upon the patients with various types of fistula-in ano.

Observations: Four techniques employed in various types of fistula-in any were analysed. These include Apamarga Theekhsna Pratisarniya Kshara applied on nonspecific low anal subcutaneous fistula-in ano, Ksharasutra Varti (alkaline wick) applied on non-specific inter-sphincteric grade Grade II fistula-in ano where there was no internal opening, Multistage Ksharasutra technique employed in an inter-sphincteric grade Grade II fistula in ano with gradual extension of track and technique of Interception of fistula track by application of Ksharasutra (IFTAK) was employed in Grade IV fistula.

Conclusion: All the above four techniques employed were effective in managing fistula–in ano. The techniques described here are the modifications of classical procedures, which acts at different level and produce intended effect of healing the fistulous track without any complication or reoccurrence. However, larger comparative clinical studies may be required to further substantiate the effectiveness of these techniques.

Key words: Bhagandara, Fistula in ano, Ksharkarma, Ksharasutra