Ksharsutra- preparation-indications & contraindications

Kshar Sutra can be defined as an Ayurvedic thread coated with herbal alkaline drug or kshar sutra is a medicated device on an Ayurvedic cutting


Authors: Dr Ranjeet Singh
Dr Manoj Kureel, MS( Ay.)


Kshar Sutra can be defined as a parasurgical method of treating ano-rectal diseases or kshar sutra is medicated device on an Ayurvedic cutting set on or coated thread prepared by repeated smearing of alkali of Achyranthes aspera, plant lalex of Euphorbia nerifolia and turmeric powder on a 20 zero Barber’s surgical linen thread. The material possesses proteolysis caustic, and antiseptic properties and promotes simultaneous cutting and healing

Kshar coating of kshar sutra

Guggul =11 coatings

Guggul + Apamarga= 7 coatings

Guggul + Turmeric= 3 coatings

Total coatings = 21

Methods of preparation of Ksharsutra

The medicated linen thread of size 20 is spread throughout the length and breadth of the hanger of the specially designed cabinet known as Ksharsutra cabinet.The thread is smeared with latex, uniformly and carefully, all around the thread, with the help of clean gauze soaked in snuhi kshira. After smearing all the threads on the hanger, the hanger is placed in the Ksharsutra cabinet for drying.

After 11 such coatings with snuhi Ksheer, 12th coating of snuhi kshira is done and wet thread is then passed through a heap of finally powdered apamarga kshar immediately. After smearing all the threads with the Kshar, the hanger is taken gently allowing the excess particles of kshar to fall down. This process is repeated in seven coatings of Snuhi kshira and apamarga kshira is achieved, thus completing 18 coatings on the thread. The remaining three coatings are performed with Snuhi kshira and fine powder of haridra as per the above said procedure making a total 21 coatings on the thread.

Finally the ultraviolet lamp of the Ksharsutra cabinet is put on daily for 20 to 30 minutes to maintain sterile atmosphere right from the first day of coating. The threads of a uniform length that is 30 to 32 centimetre are cut for packing for their the sealed glass tubes or airtight container are kept in a cabinet and exposed to ultraviolet radiation.

Indications of ksharsutra

  • Fistula-in-ano
  • Internal piles
  • Fissure in ano
  • Excision of Pilonidal sinus
  • Excision of Warts

Why only Ksharsutra?

  • Minimal bleeding.
  • Minimal hospital stay.
  • Minimal recurrence rate.
  • Minimal tissue loss.
  • Very narrow and fine scar, as comparative to ugly scar surgical incision.
  • No anal stricture, if there are no faults in the technique.

Probable Mode of Action of kshar Sutra

The combination of kshar ( alkali) of Apamarga etc. the latex of snuhi and powder of haridra is very effective against to the ano-rectal diseases. They cut, curette and heal the fistula. They also destroy the sinus and piles mass from their roots and make them fall off.

Contra indication of kshar sutra

In current practice, kshar sutra application is avoided id case of; severe systemic disorders, fistual as a complication of other diseases, and malignancies.

Complications of ksharsutra

There’re some listed complications might be occur due to faulty technique or use of improperly prepared kshar sutra

  • Proctitis
  • Inflammation of piles
  • Formation of sentinel leg
  • Dermatitis
  • Hemorrhage
  • Any other infection

How to manage complications?

  • Avoid further use of contaminated kshar sutra
  • Use of anti-biotics and anti-inflammatory drugs
  • Proper wound care