kshar-sutra was practised by the most ancient sugeon "Sushruta" about 2500 years ago for the treatment of "Nadi varna" in chikitsa sthan chapter no.17. chakrapanidatta has described the preparation 06 kshar-sutra as -"snuhee ksheere rajani churnam bhavitah punah punah " means latex of E.Neriifolia and powder of curcuma longa is smeared on thread repeatedly."Dalhana" has described "kshaar peetain sutra" means the sutra containing or dipped in kshara.
On the whole there was no proper guideline to prepare kshaar-sutra in ancient books (in terms of No.6 coatings). Late prof P.J. Deshpande alongwith Dr. SatyaRam standerdize the kshaar-sutra (11 coatings of Latex, 7 coatings Latex + kshaar and 3 coatings of Latex + powder of curcuma longa).He also develop technique of fistulogram to measure the lenghth, depth and type of fistula also.