Ksharsutra is a thread coated with certain ayurvedic medicines known for their antiseptic, debridement & healing properties. After UV sterilization this medicated thread (ksharsutra) is used under complete aseptic precautions in the patients. The patient is routinely investigated with special reference to any other associated disorder like hypertension, diabetes mellitus, tuberculosis etc. The next step lies In the proper identification & evaluation of the fistulous tract. It is mandatory to define the fistula tract wrt its depth, direction & branching pattern. This may be achieved by careful probing under expert hands using malleable probes & if required help may be taken from other investigations methods like x ray fistulogram or mri fistulogram. Once the tract has been clearly defined the ksharsutra is placed in it with the help of certain instruments, under local anesthesia. This entire procedure is usually completed in ten to fifteen mins. As there is no cutting of tissues hence no bleeding, no pain & patients can go home after half an hr rest in the day care room. The medicine coated on the thread is gradually released in the tract. The cumulative effect of the coated drugs exerts a powerful debridement effect on the fistula tract & induces healing by the fresh & healthy granulation tissues. Thus kshara sutra is the mechanism of drug delivery precisely at the tissues involved. Every seventh or tenth day the old sutra is replaced with a new KSutra till there is a finale cut through. 

It has been observed that the tract heals @ 0.5-1 cm per week. The postoperative complications like recurrence of the disease, fecal incontinence, bleeding is not seen with kshara sutra treatment. Further this therapy is performed as an OPD procedure. No general anesthesia & no hospitalization is required. Patient maintains his normal routine activities as usual during treatment period.