Fistula –in–ano is most troublesome anorectal condition which is having increased prevalence in developing countries due to lifestyle changes. In Ayurveda, Fistula –in–ano can be correlated to Bhagandara. In spite of various surgical techniques there are so many complications like delayed healing, recurrent occurrence, stenosis or incontinence. Kshara Sutra ligation is a surgical procedure having various therapeutic effects with minimal complications.58 yrs male patient with complaints of foul smelling pus discharge through base of scrotum with pain in scrotal and anal region since 4 months. On rectal examination, Presence of external opening at 11 O’ clock position near base of scrotum.Trans perineal ultrasound shows chronic Right perianal fistula with small ischioanal abscess. To manage this, Fistulotomy is planned with Kshara Sutra under aseptic precautions in first setting. Second setting, I &D (incision and drainage) was done. In the Last setting, Fistulotomy with Kshara Sutra under local anesthesia has been planned. After three surgical interventions, more than 95% of tract has been healed and less than 5 % tract is remained which had healthy granulation tissue devoid of pus discharge and pain has excised by Fistulotomy. Post operative management and follow up medications prescribed for7 days. Patient had regular follow up for 2 yrs where no reoccurrence of complaints. Hence, to treat reoccurred fistula we need multiple system approach to get 100% cure rate.