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CTMJ | traditionalmedicinejournals.com                                       Chinese Traditional Medicine Journal | 2021 | Vol4 |Issue6 
 

Chinese Traditional Medical Journal  

Case Study 
Multiple Stage Surgical Approach along with Ksharasutra Therapy in 

the Management of High Anal Fistula (Bhagandara) 
Jin Xi, Wan Je, Shen Hifen, 

Institute of Hematology, the First Affiliated Hospital of Medical School of Zhejiang University, 

Hangzhou 

Department of Oncology, the Third Affiliated Hospital of Zhejiang Chinese Medical University, 

Hangzhou 

 

 

 

 

 

 

 

 

 

 

 

 

 

Introduction 
Darana (splitting or ripping) surrounding 
Guda, Yoni, and Vasti is the literal meaning of 
Bhagandara (urinary bladder). Bhagandara 
was the first patient to benefit from the 
treatment. 

Seton placement, stulotomy, and 
stulectomy[5] are all current surgical options 
for treating ano amputations.[6] 
Pidika (boil) arises in the vicinity of Guda, and 
when it 
Fistula ligation of the inter-sphinteric (LIFT)It 
is known as Bhagandara when it breaks out. 
(1) In the list of Astamahagada (diseases that 

Abstract 
Background: Anal stulas are relatively common in today's clinical practise, and despite 
improvements in surgical procedures, treating them is a time-consuming task. Bhagandara, 
a disease mentioned in Ayurveda that is supposed to be very difficult to treat, is similar to 
anal stula. 
As a result of the difficulty of using merely Ksharasutra (alkaline seton) to treat high anal 
stulas, which have an internal opening that is above the dentate line and an exterior 
opening that is a significant distance from the anal edge, numerous surgical approaches 
have been used in this circumstance. 
 Materials & Methods: stulotomy and Ksharasutra were used in three phases to treat the 
patient. To establish hemostasis, the external incision was first expanded toward the anal 
canal by around 5 cm. Curettage and packing were also performed at this step. During the 
second step, the tract extended 2 cm toward the anal canal and was stuffed, which took 
place after a month. Ksharasutra was used in the third stage for eight weeks till the tract 
was severed and healed fully. 
Results: It was approximately a year before all of the stulous tract had healed, although the 
hospital stay was just a few days. After six months of monitoring, there was no sign of the 
problem recurring. 
The outcomes of this trial were positive, and the patient was able to return to his normal 
schedule with little hospitalisation. 
Keywords: Fistula in ano, several stages of surgery, and ksharakarma are all examples of 
bhagandara. 
 



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CTMJ | traditionalmedicinejournals.com                                       Chinese Traditional Medicine Journal | 2021 | Vol4 |Issue6 
 

are difficult to treat for both patients and 
surgeons), Bhagandara is one of them. 
[7] Expanded Adipose Derived Stem cells 
(ASCs) and Fibrin glue, among others. Stula-in-
ano surgery has several disadvantages, 
including greater pain, expense, and time. 
The Samhita of Sushruta 2 Fistula in ano, hints 
as a possible cause. 
a high occurrence rate. Treatment options 
come in many shapes and sizes. 
between two epithelial-lined surfaces, a 
persistent granulating path Even in the hands 
of the most experienced surgeons, it is known 
to reoccur. This awful sickness may be dealt 
with in a variety of ways using Ayurveda, the 
ancient science of life. In 
 

its own limitations, the use of Ksharasutra 
when the internal opening is very high 
due to an anal stula 
Corresponding address: 
 Dr. Alok Kumar 
last 4-5 decades Ksharasutra [4] has 
attained the 
Ph.D. Scholar, Dept. of Shalya Tan  
that this is most suitable treatment option 
National Institute of Ayurveda , Jaipur, 
India, 
Email:dr.alokv@gmail.com 
exterior opening far away from anal verge 
is not only difficult to diagnose and cure, 
but it also takes a long period for healing 
to take place. As a result, Ksharasutra and 
surgery may be used in conjunction to 
treat these types of instances. Excision, 
incision, and cauterization are all 
recommended in Ayurvedic literature 
along with the Ksharasutra treatment.So, 
in light of the foregoing concerns, the 
current research was organised utilising 
the conventional Ksharasutra and 
numerous rounds of surgery in the 
therapy of high anal stulas. 
Case study 
The National Institute of Ayurveda, Jaipur, 
saw a 45-year-old male patient with a 
complaint of pus discharge from the 
perianal area. Upon closer investigation, 

an aperture was discovered around 10 cm 
from the anal margin at the 8 o'clock 
position, through which pus was draining. 
Dimpling and induration were detected up 
to the anorectal ring on digital rectal 
examination, which was performed at 6- 7 
o'clock position. When the track was 
probed in full, it stretched up to the 
muscles of the puborectalis. Stulous track 
was detected on magnetic resonance 
imaging (MRI) of the gluteal area. The 
stulous track was extra-sphincteric, with a 
secondary track exhibiting trans-
sphincteric course and an interior opening 
at 6 o'clock. All of the standard testing 
was done, but no abnormalities were 
discovered. In this case, a main threading 
procedure with a partial avulsion was 
used. 
Methods Procedure 
Patients were positioned on their side and 
the perianal region was disinfected by 
using an antiseptic solution (10 percent 
Povodine iodine). Anesthesia was 
administered by injecting a 2 percent 
Xylocaine and adrenalin solution into the 
surgical site and covering it with drape 
sheets. Copper probes were introduced 
from an external orifice and tracked to 
determine the depth and direction of the 
track after it had been given the proper 
anaesthetic. An external hole of about 5 
centimetres toward the anal canal, with 
hydrogen peroxide curettage and tight 
packing, was made to establish 
hemostasis after probing (Fig. 1). Every 
day, the patient was instructed to apply a 
dressing, and he or she was accompanied 
to the OPD on alternate days for follow-up 
appointments. Extensive curettage with 
hydrogen peroxide and tight packing were 
performed to ensure hemostasis after one 
month. The patient was repositioned in 
the lithotomy position and the external 
aperture was expanded roughly 2 cm 
towards the anal canal. Similar 
instructions were given to patients. Anal 



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CTMJ | traditionalmedicinejournals.com                                       Chinese Traditional Medicine Journal | 2021 | Vol4 |Issue6 
 

canal probe was put via wound and 
removed through internal hole after 
second month of patient being in place. 
External opening was stretched about 2 
cm towards anal canal. Tight bandages 
were used to cover the wound, which had 
a lenin thread of 20 nm inserted into it. a 
normal Apamarga Kshara Sutra was used 
in lieu of the plane thread after two days 
(Fig. 2). The patient was instructed to 
apply betadine and Jatyadi Taila to the 
wound daily, as well as to use hot water 
on a regular basis. The ksharasutra was 
modified on a weekly basis and gradually 
tightened to allow the track to naturally 
cut through it. Over the course of five 
months, a total of eight Ksharasutra were 
administered, and the patient was 
monitored for a total of six months. 
Result 
Based on the patient's pain and 
discomfort, post-operative bleeding, 
hospitalisation, and recurrence of ano, 
treatment efficacy was evaluated. The 
whole treatment was conducted under 
local anaesthetic during the intraoperative 
time, therefore the patient felt no 
discomfort. On the first day, analgesics 
were given. The patient did not have any 
severe post-operative bleeding. After four 
hours of surgery, the patient was able to 
walk and there were no postoperative 
complications, such as urine retention. 
Patients were released from the hospital 
on the same day after each sitting. After 
six months, no recurrence was seen in the 
patient who had had full recovery (Fig. 3). 
Despite the fact that the therapy lasted 
almost a year, the hospital stay was only a 
few days, therefore the total cost of the 
treatment was low since the patient was 
able to continue working throughout the 
time he was in the hospital. 
 
Discussion 
Because no significant incisions are made, 
patients don't have to worry about their 

daily routines or social lives being 
disrupted after surgery. In this case, the 
patient's incision was so minor that it 
didn't need a lengthy stay in the hospital. 
When the stulous wound was excised in 
many stages, the stula became brosed and 
the brous tissue in the wound inhibited 
the creation of secondary tracts, as the 
wound contraction approached the anal 
canal. In the same way that Ksharasut the 
thread was progressively tightened during 
the previous two weeks to allow the 
remaining tract to be trimmed down. 
applied in the stulous track for last 8 
weeks. Recurrence was decreased 
because of the Kshara's Shodhana 
(cleaning) and Lekhana (scrapping) 
properties. When the track had fully 
recovered and healthy granulation tissue 
had formed, we knew that our treatment 
plan was working. It is possible that 
Ksharasutra's effect caused the tract to 
get brosed, resulting in excellent healing, 
which prevented the recurrence of 
secondary track recurrence following the 
healing of the tract which drains all 
secondary track linking to the main tracks. 
Conclusion 
There were two weeks of gradually 
increasing tension before the remaining 
tract could be cut. For the last eight 
weeks, I've been on the stulous track. The 
Kshara's Shodhana (cleansing) and 
Lekhana (scrapping) characteristics 
reduced recurrence. We knew our 
treatment approach was working when 
the track had entirely regenerated and 
healthy granulation tissue had grown. 
After the tract empties all secondary track 
connected to the main tracks, it's 
probable that Ksharasutra's influence 
induced a brosis, resulting in great  
healing. This, in turn, prevented 

secondary track recurrence.. 

References 



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CTMJ | traditionalmedicinejournals.com                                       Chinese Traditional Medicine Journal | 2021 | Vol4 |Issue6 
 

There was a two-week buildup of tension 
before the last segment could be snipped. 
I've been on the stulous path for the 
previous eight weeks. A reduction in 
recurrence was achieved via the 
Shodhanna and Lekhana (scraping) 
properties of the Kshara. Upon seeing a 
complete regeneration of the track and 
the growth of healthy granulation tissue, 
we realised that our treatment strategy 
was working. Following a brosis of 
subordinate tracks connecting to the 
major tracks, it's likely that the effect of 
Ksharasutra prompted the tract's clearing. 
Secondary-track recurrence was averted 
as a result.  
 
How to cite the article: 
Kumar Alok et al, Multiple Stage Surgical 
Approach along with Ksharasutra 
Therapy in the Management of High Anal 
Fistula (Bhagandara). J. Res. Trad. 
Medicine 2016; 2(2): 51-53 
Source of Support: Nil Con ict of 
Interest: Nil 
 
© Journal of Research in Traditional 
Medicine 2015-2016 
 
Disclaimer: Journal of Research in 
Traditional Medicine, its publisher, 
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purely the opinion of the contributing 
authors and not necessarily of the Journal. 
 

 

 

 

Fig no. 1: After First sitting 

Fig no. 2: During the third sitting 

   

                                                                  

 

 no. 2: During the third sitting