Bhagandara (Fistula in Ano) is a chronic inflammatory condition characterized by the formation of a tract between the anal canal and perianal skin. It is correlated with anal fistula in modern medicine, which is known for its high recurrence rate despite surgical interventions. In Ayurveda, Ksharasutra therapy, a minimally invasive parasurgical procedure, has been extensively advocated for its effective management. Objective: To evaluate the clinical efficacy of Ksharasutra in the management of Bhagandara with respect to symptom relief, healing time, and recurrence rate