Minimally Invasive Management of Pilonidal Sinus Using Kshara Sutra: A Clinical Case Study

Background: Nadi Vrana, described in Ayurveda, refers to an ulcer with a tubular extension. Among its five types, Shalyaja Nadi Vrana is comparable to pilonidal sinus, characterized by a tract in the natal cleft region often caused by ingrown hairs (Shalya). Conventional treatments such as wide excision and reconstructive surgical techniques are associated with a high recurrence rate. The Ayurvedic approach using Kshara Sutratherapy offers a minimally invasive alternative with promising outcomes.Aim: To evaluate the clinical efficacy of Guggulu Nimba Kshara Sutra in the management of pilonidal sinus (Shalyaja Nadi Vrana).Case Presentation: A 28-year-old male patient presented with a painful swelling and discharge in the natal cleft region, diagnosed as pilonidal sinus. The patient was treated using Guggulu Nimba Kshara Sutra, a medicated thread prepared with Ayurvedic herbal formulations. The therapy involved gradual excision of the sinus tract through periodic tightening of the thread, promoting healing.Outcome: Complete excision of the tract was achieved within a span of six weeks with minimal scarring. The patient experienced significant symptom relief, no recurrence during follow-up, and resumed daily activities without discomfort.Conclusion: This case highlights the efficacy of Guggulu Nimba Kshara Sutra in managing pilonidal sinus, offering a cost-effective, minimally invasive treatment option with reduced recurrence rates and faster recovery compared to conventional methods.