Horseshoe fistula-in-ano is a challenging problem for the proctologist due to the sepsis of the posterior anal
space. There isa high chance of reoccurrencealong with potential incontinencefollowing surgery. To address such
a grievous outcome after surgery,Ksharasutra threading was found to be beneficial in such a case. Ksharasutranot
only helped in draining the fistulous tract but, it also maintainedthe integrity of the sphincter by simultaneously
cutting and promoting fibrosis thereby resulting in maintenance of continence and was effective in draining the
post anal sepsis resulting in no reoccurrence of the disease.Keywords: Bhagandara; Horseshoe fistula-in-ano; Ksharasutra; Medicated seton.