An integral approach of ‘Fistulectomy along the arms of the Horse-shoe fistula with Ksharasutra ligation’ in the remaining track connected to the anal canal, and drainage of the postanal space abscess, proved to be very successful. After going through this, we can say that there is a definite need for newer surgical innovative techniques, to tackle this challenging disease. Therefore, in such a clinical feature neither Fistulotomy (‘Wanley operation’) nor ‘ Ksharasutra’ treatment alone, prove useful. Also, they open posteriorly into the anal canal, at the 6 o’clock position, and are associated with a big cavity lying superior (above the levatorani). Here, fistula forms secondary to an ischiorectal abscess and both the ischiorectal fossae are involved. We can correlate this with ‘ Shambukawarta Bhagandara’ described by Sushruta. Horse-shoe Fistula is a big challenge for both Modern and Ayurvedic Surgeons.
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