Shalya Tantra in the 21st Century: Where Tradition Meets Technology – A Narrative Review of Research Gaps in Preoperative, Intraoperative, and Postoperative Care

Abstract

Background: The Ayurvedic surgical science of Sushruta Samhita (c. 600 BCE) contains the principles of preoperative, intraoperative, and postoperative care. However, their integration into contemporary evidence-based surgery remains poorly investigated.

Objective: To explore the research gaps in Shalya Tantra along the perioperative continuum, discuss the possibilities of integration with contemporary surgical technology, and suggest a prioritized research agenda.

Methods: The search for Shalya Tantra, Kshara Sutra, Agnikarma, Vrana, and perioperative care was performed on PubMed, Scopus, Google Scholar, AYUSH Research Portal, Dhara Online, and CTRI (2000-2025) using these words. Reference to classical ayurvedic texts. The included studies were original research, systematic reviews, and gap‑identifying articles.

Results: Three important gaps were identified. Preoperative: No validated tools are available that can translate Rogi pariksha (eight-fold assessment) into surgical risk metrics, and no RCTs of preoperative Snehana-Swedana exist. Intraoperative: A 2024 meta‑analysis demonstrated that Kshara Sutra had a promising cure rate (p<0.03) with low recurrence/incontinence, while in the 1991 ICMR RCT, 4% of patients had a recurrence (incontinence) compared to 11% of those undergoing conventional surgery. However, no trials have compared Kshara Sutra with current sphincter‑sparing procedures (LIFT, VAAFT). There are few comparative studies on Agnikarma. Postoperative: Jatyadi tulle, Madhughrita tulle, Manjishthadi Ghrita and Panchavalkala cream are supported by RCTs and Jalaukavacharana efficacy are evident in case series.

Conclusion: Shalya Tantra has great potential to improve the level of contemporary surgical treatment. Priority research involves Kshara Sutra vs. LIFT RCTs, mechanistic studies of Vrana Ropana formulations, and hyperspectral imaging validation of Vrana classification.