KsharaSutra Pradhana Karma – Main Procedure

Article by Dr Raghuram Y.S. MD (Ay) and Dr Manasa, BAMS
As any other treatment, Kshara Sutra is also conducted in 3 stages of treatment so as to provide comprehensiveness and desired results in eradicating the problem from the base and also to prevent recurrence. 

Unlike other external treatments like abhyanga (massage), swedana (sudation), kati vasti (oil pooling for low back pain) etc and internal treatments including Panchakarma measures like Vamana (therapeutic emesis), Virechana (therapeutic purgation) etc, Kshara Sutra involves surgical process.

It is also performed on the most sensitive area of the body, i.e. anal region. Therefore it should be cautiously handled with all necessary preparations and precautions.
The physician cannot afford to create complications in these cases. Therefore the responsibility of the doctor and medical staff attending the patient who is subjected to Kshara Sutra becomes 3 fold.

Kshara Sutra procedure

Below mentioned are the 3 steps in which the Kshara Sutra treatment is conducted –
Purva Karma – Pre-treatment procedure (pre-op)
Pradhana Karma – Treatment proper, method of conducting Kshara Sutra (operative procedure)
Paschat Karma – Post-treatment procedure (post-operative procedure)

Sanskrit verse

Pradhana Karma

Pradhana Karma of Kshara Sutra includes administration of Ksharasutra:
Sushruta tells ‘After analyzing the strength and tolerance power of the patient and also after accessing the strength of alkali, the thread smeared with kshara should be introduced into the diseases tracts (sinus, fistula etc) and kept in place until the pathological paths are cut, curetted and healed’

Vagbhata tells ‘After cutting with the sharp surgical instrument, the depth and ends of the passage (of sinus etc) being probed by eshanees (probes), the kshara sutra or thread smeared with kshara should be pushed into the pathological tracts. This kshara sutra or the kshara consumed orally will cut, curette and heal these tracts’
Read related: Ksharasutra Preparation Method: Detailed Explanation

The procedure of Kshara Sutra is done following the below mentioned steps:
– Anaesthesia – Spinal anaesthesia is given using xylocaine.
– Positioning the patient – The patient is placed or positioned in lithotomy position on the operation or kshara-sutra table.
– Painting – The part to be operated (ano-rectal region or peri-anal region) is painted with antiseptic solution and draped.
– Probing the positions – Positions of piles masses or tract of sinus or fistula will be assessed.
– Catching hold – The pile mass will be held with the help of pile-holding forceps.
– Trans-fixation – Each pile mass is transfixed by passing the curved round body needle mounted with kshara sutra at its base.
– Ligation – After trans-fixation of kshara sutra, the pile mass is ligated anteriorly and posteriorly with adequate knots.

– Push back – The ligated and prolapsed pile masses are gently pushed back into the rectum.
– Irrigation – Warm water irrigation of the area is done
– T-Bandaging – is done to finish off the procedure comprehensively
– Shift – Patient is shifted to the ward or recovery room
Click to consult Dr Raghuram MD (Ayu)