Background: Hippocrates advocated the use of a seton. Ksharsutra works as a cutting and draining seton, besides that, it has antimicrobial property and chemically cauterizes the unhealthy tissue lining the fistulous tract; and thus, decreasing the recurrence rate in cases of complicated fistula-in-ano. This study aims to diagnose the recurrent complicated case of fistula-inano, to treat the case by integrated method (Partial fistulectomy with Ksharsutra), to improve the quality of life of the young patient, and assess the result of Ksharsutra with trans rectal ultrasonography (TRUS). Case Presentation: This was a case of a 32-years-old male patient with recurrent horseshoe high anal fistula operated twice at a reputable hospital in Vellore (Tamil Nadu) arrived with seton in situ. On examination, a seton was seen at 6 o'clock and a scar was seen at 2 o'clock position. Partial fistulectomy was done along with Ksharsutra. On the 20th week, the Ksharsutra got cut through and the wound healed completely. There was no pus discharge and sphincter tone was within the normal limit. Post-operative TRUS showed no evidence of fistula. Conclusion: Ksharsutra was a successful integrated intervention in recurrent horseshoe fistula-in-ano.

Keywords: Ayurveda, Bhagandara, Basti, chronic disease, seton, case report.