Introduction: In Ayurveda, Bhagandara (Fistula-in-ano) is considered under the heading of Ashtomahagada (eight major diseases) due to its notorious nature. Ksharasootra is a medicated thread, indicated in anorectal disorders, particularly for management of Bhagandara (Fistula-in-ano). Now a days in some research institute different Ksharasootra are being tried like Guggulu based, Udumbar ksheera based, etc. In this study Shallaki based Ksharasootra was tried in the management of Bhagandara. It was prepared with Shallaki Niryas (Boswellia serrata Roxb), Apamarga Kshara (alkali of Achyranthus aspera Linn.) and Haridra powder (Curcuma longa Linn.) as per the guidelines of Ayurvedic Pharmacopeia of India (API). Methodology: 15 patients of Bhagandara were enrolled from OPD of Shalya Tantra and partial fistulectomy followed by Shallaki Niryas based Ksharasootra application in remaining part of the tract was done under spinal anaesthesia. From next day of surgery sitz bath with Panchavalkala Kwatha, dressing with Shatadhauta Ghrita and per rectal instillation of 10 ml Jatyaditaila was done daily. Ksharasootra was changed with a new one by rail-road technique on weekly interval. Length of thread as well as the condition of wound was noted to assess the unit cutting time (UCT) and healing till the complete healing of fistulous tract. Result: After 5 days of operation, healthy granulation tissue was seen in the fistulectomy wound. Average unit cutting time (UCT) of fistulous tract was 8.43 days / cm. complete cutting and healing of fistulous tract was observed within one and half month in 7 patients. In 3 patients time required for complete healing was 2 months while in 2 patients it was 4 months and in 3 patients it was 5 months. Discussion: Management of a long fistulous track by Ksharasootra is very tedious job. In this study fistulous tract was partially excised so early healing of fistulous tract was observed. Shallaki based Ksharasootra have shown less burning pain during the course of treatment.. The cutting and healing of fistulous tract was early as compare to simple Ksharasootra application. Conclusion: This pilot study demonstrated that early healing with mild pain by partial fistulectomy and Shallaki based Ksharasootra in management of Bhagandara (Fistula-in-ano).

Keywords: Bhagandara; Fistula-in-ano; Ksharasootra; Partial Fistulectomy; Shallaki.