This is one of the frequently asked questions by many of my patients, especially in the anal fistula, that is the fistula in the anal canal or maybe pilonidal sinus or maybe piles also. What happens is Ksharasutra was surgery. This is the burning question in many of the patients. I would like to mention that in some of the disease that I have mentioned earlier, there are certain recurrence chances the recurrence rates are higher, it is safe and simple also and the recurrence changes are almost nil if it is performed methodically. With the conventional surgery especially with the fistula in ano or the pilonidal sinus. Their recurrence rates are considerably high, even 6 month post-surgery, I would like to mention here that anal fistula or pilonidal sinus can be treated by 2 approaches on being the Ksharasutra and the second being the conventional surgery it is a misnomer to tell that we can cure or treat that only with medicines so it is always better. It is a type of awareness that it is a surgically treatable diseases . So we have to treat them accordingly. Initially we can maintain them or fistula in ano or pilonidal sinus with the medicines and the medicines are always necessary after the Ksharasutra or even after the surgery also. But it is a misnomer to cure fistula in ano or pilonidal sinus only with medicines.