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Session:: ePosters-Sun350-M7: Benign Anorectal

EP681 - case series presentation of Medicated alkaline paste(kshara karma) in Pilonidal sinus

Sunday, May 10, 2026
4:00 PM - 4:05 PM ET

    ePoster Presenter(s)

  • DAVID PAUL RAJU MADANU, MD (he/him/his)

    proctologist
    hitam ayurvedic anorectal institute Hyderabad
    hitam ayurvedic anorectal institute,hyderabad,india
    Hyderabad, Telangana, India

    Disclosure information not submitted.

    View ePoster

    • Senior Author(s)

  • Nilesh B. Doshi, PELVIC FLOOR STEERING COMMITTEE MEMBER,ASCRS

    CHIEF SURGEON -DEVANGI HOSPITAL , MUMBAI INDIA
    1) PROF- DY PATIL SCHOOL OF AYURVED MUMBAI
    MUMBAI, Maharashtra, India

    All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

    • Author(s)

  • VG

    Venkateswarlu GADDAM, n/a

    proctologist
    DR Sarajas Anorectal centre
    Hyderabad, Telangana, India

    Disclosure information not submitted.

  • Alok Mohanlal Gupta

    Director Gupta hospital, Gupta Building, Tilakwadi, Yavatmal.
    Rashtriy Ayurved Vidhyapith
    Gupta Hospital
    Yavatmal, Maharashtra, India

    All disclosed relationships have been reviewed and managed prior to the start of this activity. Any relevant relationships will be listed below. This individual has no financial relationships to disclose

  • CR

    CHANDRAVANI RUMALA, n/a

    proctologist
    hitam
    Hyderabad, Telangana, India

    Disclosure information not submitted.

Purpose/Background: Purpose: To evaluate the efficacy, safety, recurrence rate, and patient acceptability of *Kshara Karma* in the management of pilonidal sinus.

Background:
Pilonidal sinus is a chronic inflammatory disease of the natal cleft, commonly affecting young adults and associated with pain, discharge, and recurrence. Despite several surgical techniques, no single procedure ensures complete cure. *Kshara Karma*, described in ancient Ayurvedic texts, is a minimally invasive para-surgical method using an herbal alkaline preparation that chemically cauterizes unhealthy tissue and promotes healing.

Methods/Interventions: A prospective observational study was conducted at HITAM Ayurvedic Anorectal Institute, Hyderabad, from 2017 to 2024. Four hundred patients aged 16–35 years with pilonidal sinus were included; those with systemic illnesses were excluded. The procedure was performed under local anesthesia in the outpatient setting. The sinus tract was laid open, hair and debris were removed, and freshly prepared *Kshara* paste (from *Achyranthes aspera*, *Plumbago zeylanica*, and conch shell) was applied for one minute and neutralized with lemon juice. The wound was dressed with medicated oil and followed up until complete healing. Postoperative parameters such as pain (VAS scale), healing time, recurrence, and return to work were recorded, with follow-up for three years.

Results/Outcomes: All 400 patients underwent *Kshara Karma* successfully under local anesthesia without hospitalization. The average operative time was 18 minutes. Mean postoperative VAS pain score was **2/10**, and most patients resumed normal activity within 2–5 days. Complete wound healing occurred within 3–6 weeks. No major complications were noted. Only **3 patients (0.75%)** showed recurrence during the 3-year follow-up, all of whom responded to repeat *Kshara Karma*. The procedure was found to be simple, cost-effective, and well accepted, with 96% patient satisfaction.

Conclusion/Discussion: *Kshara Karma* is a safe, effective, and minimally invasive alternative for the treatment of pilonidal sinus. It provides excellent healing with minimal postoperative pain, early recovery, and a very low recurrence rate. This traditional Ayurvedic technique integrates seamlessly with modern proctological practice and can serve as an ideal office-based day-care procedure. Larger controlled studies are warranted to further validate these findings and establish *Kshara Karma* as a globally recognized, evidence-based treatment option for pilonidal sinus.

pilonidal sinus pre operative
pilonidal sinus with multiple pits

pilonidal sinus post procedure after 6 weeks
healed well