Modified ksharasutra chikitsa for 'shambukawarta bhagandara'.

Horse-shoe Fistula is a big challenge for both Modern and Ayurvedic Surgeons. We can correlate this with 'Shambukawarta Bhagandara' described by Sushruta. Here, fistula forms secondary to an ischiorectal abscess and both the ischiorectal fossae are involved. Also, they open posteriorly into the anal canal, at the 6 o'clock position, and are associated with a big cavity lying superior (above the levatorani). Therefore, in such a clinical feature neither Fistulotomy ('Wanley operation') nor 'Ksharasutra' treatment alone, prove useful. After going through this, we can say that there is a definite need for newer surgical innovative techniques, to tackle this challenging disease. An integral approach of 'Fistulectomy along the arms of the Horse-shoe fistula with Ksharasutra ligation' in the remaining track connected to the anal canal, and drainage of the postanal space abscess, proved to be very successful. We have tried the same technique with very good results. No recurrence was found in the patients during the follow-up period of three years. The given diagrammatic presentation of the plan of surgery will help to understand the procedure.