Abstract

Background: Bhagandara (fistula-in-ano) is described in Ayurveda as one of the Ashtamahagada (Eight grave diseases) due to its chronicity and recurrence. Conventional procedures such as fistulotomy, seton placement, Ksharasutra (Medicated alkaline thread) therapy, and laser ablation are effective but associated with recurrence, prolonged treatment duration, sphincter injury, and patient discomfort. Agnikarma (Thermal cauterisation), described by Acharya Sushruta as superior to other para-surgical procedures, offers controlled tissue cauterisation. Objective: This study was aimed at evaluating the modified intra-tract Agnikarma technique using electrosurgical coagulation for low subcutaneous fistula. Clinical Presentation and Findings: Five patients with singletract, low subcutaneous fistula-in-ano (tract length ≤4 cm) presented with external opening and intermittent discharge without sphincter involvement or abscess formation. Tracts were confirmed clinically by probing. Diagnosis, Intervention, and Outcomes: Patients underwent single-session intra-tract Agnikarma using controlled electrosurgical coagulation. Follow-up for 21 days assessed pain, discharge, inflammation, granulation, and closure. All patients demonstrated progressive granulation and complete healing within 14–21 days without complications. Conclusion: Intra-tract Agnikarma appears to be a safe, minimally invasive, single-session alternative for selected low subcutaneous fistulas. Larger controlled trials with longer follow-up are needed to validate recurrence outcomes.

Key words: Agnikarma; Bhagandara; Fistula-in-ano; Thermal ablation; Low anal fistula