Sushruta Clinic-

Kshar Sutra

Kshar sutra is a medicated phytogenic alkaline thread prepared by smearing the latex, powder and kshar of
certain herbs repeatedly for 21 times which is dried in sunlight or special Kshar Sutra cabinet. It was 1964
when Dr. P.J. Deshpande in Vanaras Hindu University started the research work on role of Kshar sutra in
fistula in ano. He worked for twenty years on Kshar sutra and fistula in Ano and standardized it. His research
on Kshar Sutra and anal fistula has changed the pattern of treatment of Anorectal surgical diseases. We
also have our own Ksar Sutra manufacturing unit in Bareilly, UP, India.


With the changes in diete and life style, the incidence of anorectal disease is greatly increased. The most
common diseases occurring in anorectal region are piles, Fistula in Ano, Anal fissure, rectal polyp etc.
These Anal diseases are mostly neglected and ignored on behalf of the patients and physicians both.
Sometimes the disease becomes most complicated and incurable even fatal. The operative results of
anorectal diseases are not aways satisfactory even with skilled hand. Sometimes recurrence and
incontinence for faeces and flatus may occur after anal surgery. Occasionally anal stenosis may occur after
operation for piles where anal opening becomes extremely narrowed. Due to these post operative
complications the patients life becomes miserable and quality of life is disturbed. In these circumstances the
Kshar Sutra has given a new hope of light to the patients suffering from, Piles, Fistula in Ano, Anal fissure,
Rectal polyp, Rectal prolepse, Pilonidal sinus, & post operative anal stenosis. 
The recurrence rate of Anal diseases after surgery varies from 10-50% in different diseases where as from
Kshar Sutra treatment the cure rate is 98-100% with Negligible recurrences or complications. 
Stem of Euphorbia Neriifolia. The Latex of this plant is used for smearing the threads. (Fig. 1)
Tubes Containing caustic threads. (Fig. 2)
Preparation of Kshar Sutra

The threads are prepared on surgical linen size 20 by repeatedly smearing it with the latex of euphorbia
neriifolia and a combination of certain vegetable caustics grown on a large scale in India and other parts of
Southern Asia. These substances are:

     Fresh latex collected from the plant euphorbia neriifolia (euphorbiaceae family) by stabbing the stem at 
     various places ( Fig.1).

     A specially prepared alkaline powder derived from the plant achyranthes aspera (amaranthaceac
     family).This powder is obtained by the evapouration of the filtered soloution of burnt ashes of this plant in
     water. This method is indigenous to the Indian system of medicine and is termed "Ksharapatan". The
     powder thus obtained, is also caustic and is locally used as a debriding agent in chronic non healing
     ulcers. It has a pH range of 8 to 9.2.

     A fine powder of the dried rhizomes of curcuma longa, (ascitaminacea family). These rhizomes are c
     commonly used as ingredient of spice and are commonly termed as tumeric.

The processing of the thread is done inside a specially designed cabinet This cabinet is provided with a device hot blower for drying the threads and an ultra violet light for sterilization. The temprature of the chamber is recorded with the help of a thermometer.
The cabinet contains 25 hangers on which the surgical linen No. 20 is spread and hooked throughout. After dissolving dry latex of Euphorbia Neriifolia in chloroform, the coatings are done over thread hooked in to the hanger and put in to the cabinet for drying.

This process is repeated for three times. Then fresh latex of Euphorbia Neriifolia is coated over thread and passed through alkine power of Achyranthes Aspera and put for drying in the cabinet, this process is repeated for 4 times. Last 2 coatings are done by latex of Euphorbia Neriifolia and powder of curcuma longa, in the same manner. During processing the thread are sterilized by U.V. light. In the last, after completely drying the threads are cut from the hanger and sealed in the air tight test tubes.
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