INTRODUCTION: Surgical excision is the standard treatment for pedunculated lipomas, which are benign fat tissue tumours. Medaja Granthi is corelated with this disorder. An efficient minimally invasive Para surgical technique recommended for its treatment in Ayurveda is ksharasutra ligation. MATERIALS AND METHODS: In this case report, a 34-year-old male patient came with complaints of swelling at the posterior aspect of the peri anal region, which was of normal skin color, mobile, nontender without any dilated veins & elevated local temperature since 10 years and was diagnosed as Medaja Granthi. He was treated with Tankana Ksharasutra ligation locally along with Triphala Guggulu, two tablets twice a day orally with lukewarm water for 10 days, and Jatyadi Taila local application at the base for 15 days. RESULTS AND CONCLUSIONS: In this case study, the pedicle of the lipoma de-sloughed completely on the 10th day of Ksharasutra ligation. Thus, Tankana Ksharasutra therapy showed promising outcomes in pedunculated lipoma treatment without any adverse effects.