Kshar sutra ppt by Prof.Dr.R.R..deshpande

Kshar sutra ppt
• Presented for welfare of Ayurvedic
students ,By ---
• Prof.Dr.R.R.Deshpande
• www.ayurvedicfriend.com
• Mobile – 922 68 10 630
• Mail ID –
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3/18/2015 1Prof.Dr.R.R.Deshpande

Special Thanks for
His Knowledge & Guidance & References
• Dr.B.N.Deshpande,Professor & HOD
,Dept of Surgery ,CARC,Nigdi ,Pune 44
• BAMS & AVP (Surgery)
• Dr.B.N.Deshpande had performed N
number of Ksharsutra Procedures in
Ayurved Hospital ,Nigdi,Pune

God of Health = God Dhanvantari

Anatomy of Ano rectal region

Fistula in Ano ( Bhagandar)
• Bhagandara = Bhag + Daran
• Bhaga = Yoni ( Bhavamishra)
• Bhaga = Peri anal region
• Daran = Tare of surface

3 Stages of Fistula in Ano
• 1) Formation of Papule
• 2) Suppuration ( Abscess formation)
• 3) Burst open of suppuration

What is Fistula ?
• Abnormal communication between 2
epithelium is called as fistula.
• Latin – Fistula = Hollow pipe
• This hollow tract connect 2 body cavaties
or 1 cavity & the body surface

Causes of Fistula in Ano
• 1) Sequel of Ano rectal abscess
• 2) Tuberculosis
• 3) Ulcerative colitis – develop regional
proctitis
• 4) Cancer of Rectum or Anal canal
• 5) Lymphogranuloma venerum
• 6) H/O – Ano rectal or Gynaec Surgery

Types of Fistula in Ano
• 1) Low Level ( anal) – Normal
Fistulectomy may be compatible with
Ayurvedic Ksharutra
• 2) High Level ( anal ) – Modern
Fistulectomy has always a danger of
complication like Incontinence of
Faeces.So Ayurvedic Ksharsutra is better
option

Ksharsutra
• This is the Treatment of choice in fistula in
ano
• A surgery without Knife
• This is the only Ayurvedic surgery ,which
remains time tested & now even
recommended by Modern Ano rectal
Surgeon ( Dr.Raghunath Godbole –
recommends for High level fistula – to
avoid Incontinance of Urine)

Examination of patient
• 1) P/R Examination in left lateral position &
with handgloves
• 2) Inspection for number of openings
,position & character of them
• 3) Discharge nature
• 4) Scar of previous surgery
• 5) Palpation of tract

P/R Examination

Perianal Abscess &
Fistula in Ano

Piles

Ano rectal problems

Formation of Haemorroids

Anal Fissure & Fistula

Can you imagine pain
of Anal fissure ?

Tracts of Fistulae

External & Internal piles

Kshar ( Chemical cautery)
• 1) Kshar = Substance ,which cuts the
devitalized tissue & having property of
cleansing ( Shodhan).
• 2) Kshar --- Alkali in nature
• A) Mrudu Kshar ( mild) = PH 8.4
• B) Madhya Kshar( moderate) = PH 9.2
• C) Tikshna Kshar (strong) = PH 9.4

Kshar
• 1) Mainly prepared by Herbs ,which
contain Sodium carbonate ,potassium
carbonate ,calcium oxide ,magnesium
oxide ,silica

Material for preparing
Ksharsutra
• 1) Cotton thread number 10
• 2) Binding agent – Udumber Ksheer or
Gum ekesia
• 3) Kshar
• 4) Turmeric ( Haridra)
• 5) Water

Apamarga for Kshar

PH Values of Kshar

Ksharsutra Preparation

Making of Ksharsutra

Drying of Ksharsutra –
Dryer or oven

Ksharsutra – Ready to use

Preparation of Ksharsutra
• 1) Prepare solution of – Kshar(Apamarga or Arka) 1
part + Turmeric 3 parts + Udumbar ksheer or powder of
Gum ekesia
• 2) Add sufficient quantity of water .This solution should
not be too thick or too watery
• 3) Dip cotton thread in this solution .Dry it in cool place
• 4) Repeat this procedure for 11 times
• 5) After preparation,Kshar sutra is kept in Formalin
Chamber

Patient Examination
• Pain of the patient can be graded as 0 to 3
( No pain, Pain during defaecation
only,Pain releived by Sitz’s bath,Pain
releived by Analgesics)
• Burning sensation also can be graded as 0
to 3 (No Burning Sensation, Burning only
after defecation, Intermittent Burning &
Continuous burning)

Patient Examination
• Pus Dischage graded as 0 to 3 ( No
pus,Dischrge only during
defaecation,Intermittent discharge,Pus
dischage with soiling of cloth)

Patient Examination
• Perianal region is examined for –No of
openings, Location of openings,
Discharge,Colour of Peri anal skin,
Condition of sphincter on staining, Scar of
previous surgery
• By Palpation – Check Increased Local
Temperature, Tenderness, Feel of Tract

Patient Examination
• PR Examination or Digital Examination is
done in Left Lateral Position for Palpation
of Internal opening,Spincter tone & to
palpate any other Pathology like Tumour
or ulcer

Examination
• Proctoscopy
• Fistulogram
• Other base line Investigation like
Haemogram,
Urine,Stool,BSL,Urea,Creatinine,Cholester
ol,BT & CT,ECG etc

Drugs
• Haridra( Curcuma longa),
• Arka ( Calotropis procera),
• Udumber (Ficus racemosa),

Action of Ksharsutra
• Kshar has a action of Vrana
Shodhan,Lekhan & Ropan (
Cleansing,Scrapping & Healing)
• Kshara sutra does not allow to track close
abruptly & allow pus to drain
• Fistulous Track is cut by Chemical cautery
• UCT of Arka is 1 cm in 8 days & UCT of
Apamarga is 1 cm in 7 days

Comparison of Arka & Apamarga
• Although Arka is supposed to be stronger
by it’s Hot & cutting property ,in Practice
Apamaga Kshar can show better results
due to –
• Apamarga has good healing property &
less burning
• With Arka Ksharsutra,some times
unhealthy Hypergranulation is noted

Surgical Instruments

Procedure -- 1
• 1) Routine Lab
• 2) If H/O recurrence – Colonoscopy &
Fistulogram
• 3) Appropriate Local Anaesthesia( Spinal
at L4 & L 5)
• 4) Lithotomy position
• 5) Painting with spirit & povidone Iodine &
draping

Procedure -- 2
• 6) Inject Betadine + Hydrogen peroxide from
external opening & observe internal opening ,by
putting Seem’s speculum
• 7) Probing is done with Malleable probe of silver
,costing Rs.200 /- ,which is washed thoroughly
after procedure & kept in formalin Tablets
chamber ( Take precaution that not to create
false passage )

Procedure -- 3
• 8) Probe is expected to come out from
internal opening in the rectum ( confirmed
by injecting Betadine + Hydrogen peroxide
solution
• 9) Insert Ksharsutra & tight knot is applied
• 10) Go for Lord’s dilatation for painless
defecation

Ksharsutra application

Procedure -- 4
• 11) R/O any other pathology by doing P/R
& Proctoscopy
• 12) Insert Voveran( Diclofenac)
suppositories to avoid post operative pain
,with Jatyadi Taila varti as a lubricating
agent

Post operative Management
• 1) NBM for 3 to 4 hours
• 2) Soft & bland diet for a week
• 3) Anti biotics ( Inj Taxim 1 Gm I / V – BD ) &
Analgesics for a week
• 4) Then Saptavinshati Guggulu 2 BD +
• 5) Gandhak Rasayan 2 BD
• 6) Daily Sit’z bath
• 7) Change of Ksharsutra after 7 or 10 to 15
days

Ksharsutra Indication

Healing complete with
Kshar sutra

Warts on neck – another
indication for Ksharsutra

Planter Warts

Wart around anus

Wart on fingers

Advantage of Ksharsutra
• 1) Can perform under LA ( If it is low level &
patient is cooperative )
• 2) Huge wound can be avoided
• 3) No dressing ,No Pain
• 4) Short stay in hospital ( 1 or 2 days)
• 5) Much economical
• 6) Can attend normal duties from 3rd or 4th day &
on any vehicle
• 7) Negligible recurrence

IMP Advantage of Ksharsutra
• There is no fecal Incontinence in High
level fistula because
• 1) cutting & healing of fistulous Tract is
simultaneous procedure .This is chemical
cautery
• 2) This is surgery without knife ,so less
chances of getting fibers cut of sphincters

Dr.Bhalchandra N Deshpande
• Professor & HOD ,Dept of Surgery
,CARC,Nigdi ,Pune 44
• BAMS & AVP (Surgery)
• Article published in Ayurvidya magazine
,Jan 2012
• Got 1st prize of Best Article ,by Dr.Ranade
Foundation

Kshar sutra Learning

Book to purchase

CME on Ksharsutra

Start Ksharsutra Clinic

3/18/2015 Prof.Dr.R.R.Deshpande 59
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Kshar sutra ppt by Prof.Dr.R.R..deshpande

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