Fistula-in-ano is a condition which has been recognized as troublesome surgical disease due to its recurrent nature. Almost all the surgeons starting from Acharya Sushruta to the reputed surgeons up to the minute have realized the difficult course of this disorder as far as its surgical as well as medical management is considered. Treatment of fistula-in-ano is always a challenging task for the surgeons and the patients as well. The Ray of hope is provided by Ayurveda in combating this ailment. "Ksharsutra " is an excellent Para surgical procedure for management of Fistula in ano and possible decrease in its reoccurrence. An attempt has been made to review all the references mentioned regarding the preparations of ksharsutras and modifications made in it to improve its utility.