Kshara Sutra Therapy (Kshara Sutra ligation Treatment)

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Kshara Sutra Therapy (or Kshar Sutra Treatment) is a unique ancient technique, which is proved to be an effective treatment of anorectal disorders. It is commonly recommended in patients suffering from hemorrhoids, pilonidal sinus (PNS) and fistula-in-Ano.

Kshara Sutra ligation Treatment is less invasive than modern anorectal surgeries and has better results in the proper treatment of pilonidal sinus and fistula. It is also a safer option, which is also very cost effective for patients. The procedure can be categorized under parasurgical treatments. Nowadays, it is widely accepted and recognized procedure for fistula treatment in India.

What is Kshara Sutra?

Kshara Sutra is a medicated linen thread prepared with a coating of Snuhi Ksheera, Apamarga Kshara and Haldi Churna. These herbal ingredients are:

Snuhi Ksheera – Fresh Stem Latex of Euphorbia Neriifolia (Sehund or Thuhar) PlantQ.S.
Apamarga Kshara – Achyranthes AsperaQ.S.
Haldi Churna (Turmeric Powder) – Curcuma LongaQ.S.

Kshara Sutra has 11 coatings of Snuhi Ksheera, 7 coatings of Snuhi Ksheera and Apamarga Kshara and 3 coatings of Snuhi Ksheera and Haldi Churna.

Alone Snuhi Ksheera11 Coatings
Snuhi Ksheera + Apamarga Kshara7 Coatings
Snuhi Ksheera + Turmeric Powder3 Coatings

Kshara Sutra Preparation Method

  1. Take surgical linen thread of size 20.
  2. Spread it on the hangers of special Kshara Sutra cabinet fitted with an ultraviolet lamp.
  3. Now, smear Snuhi latex using clean and sterilized gauze piece soaked in Snuhi Ksheera on linen thread uniformly.
  4. Place hangers with smeared linen thread in Kshara Sutra cabinet for drying and close the door of the cabinet to prevent contamination. Leave it for drying.
  5. When linen thread is completed dry and again smear the threat with Snuhi Ksheera. Repeat this process 11 times on same thread.
  6. After 11 coating with Snuhi Ksheera, from the 12 coating, smear the same thread with Snuhi latex then pass the wet thread through the finely powdered Apamarga Kshara heap and ensure Apamarga Kshara is attached to the thread uniformly. If Apamarga Kshara adheres to the thread in excess, then shake the thread hanger gently allowing falling down the excess particles of Apamarga Kshara. Now, Place hangers with smeared thread in Kshara Sutra cabinet for drying and close the door of the cabinet to prevent contamination. Repeat this process for total 7 times.
  7. After 7 coating with Apamarga Kshara (after 18 total coating), now start coating with Haldi Churna. Take same thread for 19th coating with Snuhi latex and now pass the wet thread through the finely powdered Haldi (Turmeric) Churna heap and ensure Haldi adheres to the thread uniformly. If the excess adheres, then shake the thread hanger gently allowing falling down the excess particles. Leave it for drying in the cabinet. When a thread is completely dry, then repeat this step 2 times more to complete 3 coating with Haldi. Now, total 21 coatings are done on thread and thread is called Kshar Sutra and ready for use.
  8. After completion of above steps, dry Kshara Sutra should be cut in the uniform length of 30 to 32 cm and packed in sterilized packaging.

Note: Kshara Sutra cabinet is fitted with an ultraviolet lamp, which should be switched on daily for 30 minutes to keep sterilize atmosphere within the cabinet.

Characteristics of Kshara Sutra

A well prepared Kshara Sutra is uniformly smeared with medicinal coating and smooth to touch. The color of thread is likely to be dark brown.

Indications of Kshara Sutra Treatment

  • Fistula-in-Ano
  • Pilonidal Sinus (PNS) or Pilonidal Cyst – a small abscess or cyst that develops in the cleft at the top of the buttocks.
  • Sentinel piles – external lump developed around the rectum due to anal fissures
  • Hemorrhoids
  • Anorectal Polyps
  • Warts

Kshara Sutra Treatment of Fistula-in-Ano

Kshara Sutra is passed through the fistulous tract using the minor surgical technique, which gradually cuts and heals the track of Fistula-in-Ano. It naturally curettes the track and remove the unhealthy tissue. It promotes drainage of discharge or pus from the tract, which helps to clear the infection. Ultimately, it cures the Fistula-in-Ano.

It may take 3 to 4 weeks for proper healing. Kshara Sutra is replaced with new one after every week.

Kshara Sutra Treatment of Pilonidal Sinus

Kshara Sutra is passed through the opening of the sinus to the skin. It gradually cuts and heals the pilonidal sinus by removing unhealthy tissue and promoting quick healing because of caustic action.

Like Fistula-in-Ano, it may also take 3 to 4 weeks for proper healing. Kshara Sutra is replaced with new one after every week.

Kshara Sutra Treatment of Hemorrhoids

The base of Pile mass is ligated with Kshara Sutra using a minor surgical technique. Yashtimadhu oil dipped pack is placed inside the rectum to reduce or soothe the irritation occurring due to Kshara Sutra. Caustic thread strangulates the blood vessel, which leads to ischemic necrosis of ligated pile mass. It ultimately sloughs the dead tissue within 6 to 7 days and heals the wound within 10 to 15 days.

Kshara Sutra Treatment of Warts

Warts are ligated with Kshara Sutra, which stops the blood supply to the wart tissue and causes ischemic necrosis. Ultimately sloughs dead tissue of warts sloughs within 6 to 7 days.

Benefits of Kshara Sutra Technique

Kshara Sutra Technique is very beneficial curing diseases listed under indication section above. This technique is safer than other surgical procedures and all patients can get treatment with this technique because it is curative and very cost effective. It also prevents recurrence. A minimum recurrence is observed with Kshara Sutra in comparison to other surgical procedures. There are surgical complications of Kshara Sutra therapy.

Other surgical procedure can cause stricture, stenosis, delayed healing, edematous tags, and incontinence. These complications are not occurring with Kshara Sutra treatment.

Contraindications of Kshara Sutra

If lesions are away from the anorectal canal, Kshara Sutra should not be used. Here is a list of its contraindications.

  • Appendicitis
  • Inflammatory bowel disease (IBD) – Ulcerative colitis & Crohn’s disease
  • Intestinal malignancies
  • Tuberculous abscess of the abdominal wall
  • Osteomyelitis of femur
  • Osteomyelitis of pelvic bones
  • Pelvic malignancies
  • Regional ileitis
  • Spinal Tuberculosis
  • Tuberculosis of hip joint
  • Urethral sinuses
  • Urethral stricture
  • Venereal diseases

Post Procedure Instructions for Patients

After Kshara Sutra treatment of anorectal disorders, the patient should follow the instructions given underneath:

  • Don’t take spicy and fried foods.
  • Take normal diet, which is light and easily digestible.
  • Take foods rich in fiber content. Taking fresh fruits and vegetables is a good choice.
  • Drink plenty of water.
  • Stay active most of the time of the day.
  • Avoid sitting, standing, traveling and driving for a longer period.
  • Avoid
  • Avoid low fiber foods.
  • Avoid constipation. If constipation occurs, take Isabgol Sat (Psyllium husk), Swadishta Virechan Churna or other mild laxatives and consult your doctor immediately.
  • Keep good hygiene of anorectal area and clean it properly.

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