Modified and more efficient seton techniques are widely practiced in the management of fistula-in-ano, particularly in Ayurveda. After constant researches and evolutions ksharasutra is considered to be the gold standard in the treatment of anal fistula. The highlights of the ayurvedic caustic thread are the limited use of local anesthesia, simultaneous cutting and healing of the tract, and that it is an OP based procedure, aiding the patients to rejoin their normal activities during the procedure itself. The standard ksharasutra is prepared by repeated coatings of snuhi ksheera (Euphorbia nerrifolia), apamarga kshara (Achyranthus aspera Linn.) and haridra churna (Curcuma longa) over a sterilized no.20 surgical linen thread. Various modified setons are now in vogue, as also quasi seton techniques like IFTAK and tube in tract. This study aims at a comprehensive review of ksharasutra weighing upon the advantages and disadvantages of different types of setons including ksharasutra, thereby allowing the surgeon to choose the right seton and techniques depending upon the stage, size, location, complication and exact pathology of any.

Keywords: Seton, ksharasutra, snuhi ksheera, apamarga kshara, haridra churna, bhagandara, fistula-in-ano.