Ksharasutra is a Sanskrit phrase, kshara stands for anything that is corrosive or caustic and sutra means thread. The ksharasutra is a medicated thread of alkaline in nature prepared by smearing it with various herbal and/or herbo-mineral substances.
Treatment with ksharasutra is a unique therapy mentioned in Sushrut Samhita of Maharshi Sushrut, the father of surgery, for the management of piles and sinus or fistula. Description of Ksharasutra is also available in various Ayurvedic treatises like Charaka Samhita, Ashtanga Hridaya, Chakradatta, Bhavaprakash Samhita, BhaishajyaRatnavali, Rasatarangini, Rasakamadhenu etc. The efficacy of this therapy was re-established by the Dept. of Shalya Tantra, Banaras Hindu University and later period revalidated by scientific organizations like CCRAS and ICMR. This technique is being practiced widely in our country and in some other countries for the management of anal fistula, hemorrhoids and other sinus diseases.
The commonly used ksharasutras are prepared with latex of Euphorbia neriifolia (snuhi), alkaline ash of Achyranthes aspera (apamarga) and powder of Curcuma longa (haridra). Various other ingredients are also used following textual references and researches for the preparation of ksharasutra and is prescribed accordingly depending on the clinical condition. Ksharasutras are dried up and exposed to ultra-violet (UV) rays keeping them in a specially designed cabinet. These ksharasutras are preserved in an air-tight container for six months.
What are the diseases treated with ksharasutra?
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- Anal fistula (fistula-in-ano)
- Piles (hemorrhoids)
- Pilonidal sinus
- Rectal polyp
- Anal polyp
- Wart
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Application of Kshara Sutra in Fistula-in-ano
The patient is anaesthetized with local or spinal or general anesthesia, then a malleable probe is passed through the external opening of the fistula to the internal opening in the anal canal and probe is gently taken out through anal opening to outside along with a Kshara Sutra in the groove of the probe. Later both ends of the Kshara Sutra is tied together. The Kshara Sutra is replaced by a new one after an interval of one week. The Kshara Sutra gradually cuts and heals the tract. Finally the whole fistulous tract heals after cutting.
Mechanism of action of Kshara Sutra in Fistula-in-ano -
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- It helps is cutting, curetting, draining and healing of the fistulous track.
- It destroys and removes unhealthy tissue and promotes healing of the fistulous track due to caustic action.
- Controls infection by the microbicidal action.
- Separation of debris and cleaning the wound.
- Facilitate in drainage of pus in fistulous tract and help in healing.
- Cutting through the tissues and laying the track open.
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Application of Kshara Sutra in Haemorrhoids
The patient is anaesthetized with local anesthesia. First pile mass holding with pile holding forceps and bring them out of the anal orifice, then give incision at mucocutaneous junction. Later slight pull exerted over the pile mass and transfixed by Kshara Sutra at the base. Ligated pile mass replaced inside the rectum and rectal pack with Yastimadhutaila or ghrita.
Mechanism of action of Kshara Sutra in Haemorrhoids
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- Chemical cauterization and mechanical strangulation of the blood vessel.
- Local tissue sclerosis.
- Ischemic necrosis and debridement of unhealthy tissue.
- Sloughing of the mass within 5-7 days.
- Healing of the resulting wound takes 10-15 days.
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Application of Kshara Sutra in Pilonidal Sinus
The patient is anaesthetized with local anesthesia and then a malleable probe with Kshara Sutra is passed through the external opening of the pilonidal sinus to the skin. Later both ends of the Kshara Sutra is tied together. The Kshara Sutra is replaced by a new one after an interval of one week. The Kshara Sutra gradually cuts and heals the sinus tract.
Advantages of Kshara Sutra Therapy
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- Simple and safe parasurgical procedure.
- Cost-effective and ambulatory.
- Minimal recurrence rate.
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