Dr. Kamathe Piles Hospital

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KSHARASUTRA THERAPY (MEDICATED CAUSTIC THREAD)

Introduction

Ksharasutra therapy, a minimally invasive and well-established Ayurvedic approach, is a proven method for managing Anorectal disorders. This safe, reliable, and cost-effective treatment is particularly effective for conditions such as fistula-in-ano, hemorrhoids, and other sinus diseases.

While the ancient Ayurvedic texts of Sushruta, Charak, and Vagbhata originally described this therapy, its effectiveness was reaffirmed by the Department of Shalya Tantra at Banaras Hindu University. Subsequently, scientific organizations like WHO, AAYUSH Ministry Govt. of India, CCRAS and ICMR further validated its efficacy. This technique is now widely practiced not only in our country but also in various other nations.

Preparation of Ksharasutra

The Standard Ksharasutra undergoes a preparation process involving 11 coatings of Snuhi latex (Euphorbia nerifolia), followed by 7 coatings of Snuhi latex and Apamarga Kshara (Achyranthes aspera), and finally, the last 3 coatings consist of Snuhi latex and Haridra Churna (Curcuma longum). The pH level of Apamarga Ksharasutra is recorded at 9.72.

Indications

Fistula-in-ano, hemorrhoids, pilonidal sinus, rectal or anal polyps etc. 

Application of Ksharasutra in Fistula-in-ano

Following the administration of local, spinal, or general anesthesia, the patient undergoes a procedure wherein a flexible probe is inserted through the external opening of the fistula, traversing to the internal opening in the anal canal. Subsequently, the probe is gently guided out through the anal opening, carrying with it a Ksharasutra positioned within the probe’s groove. The two ends of the Ksharasutra are then securely tied together. After a week, the Ksharasutra is replaced with a new one. Over time, the Ksharasutra gradually cuts and promotes healing of the fistulous tract. Ultimately, the entire fistulous tract heals following the cutting process.

Mechanism of action of Ksharasutra in Fistula-in-ano

  • 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.

Application of Ksharasutra in Haemorrhoids

The patient is administered local anesthesia for numbing. Initially, the pile mass is gripped using pile-holding forceps and gently brought out of the anal orifice. Subsequently, an incision is made at the mucocutaneous junction. A gentle pull is applied to the pile mass, followed by transfixing it at the base using Ksharasutra. The ligated pile mass is then carefully repositioned inside the rectum, and a rectal pack is applied using Yastimadhu taila or ghrita.

Mechanism of action of Ksharasutra in Haemorrhoids

  • Chemical cauterization and mechanical strangulation of the blood vessel.
  • Local gangrene of the pile mass tissue.
  • Ischemic necrosis and debridement of unhealthy tissue.
  • Sloughing of the mass within 5-7 days.
  • Healing of the resulting wound takes 10-15 days.

Application of Ksharasutra in Pilonidal Sinus

Local anesthesia is administered to anesthetize the patient, following which a flexible probe containing Ksharasutra is inserted through the external opening of the pilonidal sinus to the skin. Subsequently, both ends of the Ksharasutra are securely tied together. After a week, the Ksharasutra is replaced with a new one. Over time, the Ksharasutra delicately cuts through the sinus tract, facilitating healing.

Advantages of Ksharasutra Therapy

  • Simple and safe parasurgical procedure.
  • Cost-effective and ambulatory.
  • Minimal recurrence rate.
  • No any complications
  • Systemic diseases are also undergoing this procedure.
  • No surgical complications like incontinence, stenosis and stricture.
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