Efficacy and safety of Kshara Sutra therapy for the management of anal fistula – A meta-analysis

Abstract

Nowadays, many novel approaches are being tested and practiced in search of the ideal treatment for anal fistula but the best technique is not known. Although comparative clinical trials are being done globally for anal fistula but drawback and limitations are associated with every intervention so we are not able to reach the final conclusion that which approach is best for the management of this perplexing disease and the available evidence suffers from lack of high-quality data with very few large RCTs. Ayurveda science also actively contributes Kshara Sutra application for anal fistula management in Sushruta Samhita and many studies also conducted in various institutions on this methodology but no comparative quality data are available which can help to gain global recognition and acceptance. To find out the efficacy and safety of Kshara Sutra therapy in Anal fistula, a sincere attempt has been made by searching PubMed, Web of Science, and Scopus databases and published information from January 2000 to May 2023 are recorded. A total of 7 articles were included in this meta-analysis with Jadad scores ranging between 4 to 7 for 6 studies and score of 3 for 1 study signifying overall good quality of the articles. The cure rate considering unit cutting time of the fistula tract with Kshara Sutra therapy was found highly significant and negligible rate of recurrence and anal incontinence. Existing literature data reveal Kshara Sutra therapy may be the minimally invasive surgical procedure with promising cure rate and lowest incidence of recurrence and anal incontinence.

Keywords

• anal fistula
• ayurveda
• bhagandara
• kshara sutra
• meta-analysis
• sushruta