BN Gadve and Kalyani Vilasrao Kale

Kshara Sutra therapy, a para-surgical Ayurvedic technique involving the use of a medicated alkaline thread, has been traditionally employed for managing Nadi Vrana (sinus) and Bhagandara (fistula-in-ano), as described by Acharya Sushruta, often regarded as the "Father of Surgery." This method has significantly transformed the management of fistula-in-ano, a condition known for its tendency to recur and the potential risk of incontinence. While the classical Kshara Sutra technique likely predates modern seton procedures, and remains a valuable surgical option, it also presents challenges such as prolonged treatment duration, repeated hospital visits, post-procedural discomfort, and patient anxiety.
To address these limitations, a modified technique IFTAK (Interception of Fistulous Tract with Application of Kshara Sutra) has been developed. This approach aims to reduce treatment duration, minimize post-operative scarring, and alleviate the drawbacks associated with the conventional method. The surgical plan is illustrated in Figure 1 to aid in procedural understanding. In the case presented, complete healing was observed within four weeks, with no recurrence reported during a one-year follow-up period.

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