Ksharsutra Ligation       -      Fistulectomy Fistulotomy       -       Fibrine Glue - Managment for Anal Fistula       -       Core Technique For Anal Fistula       -       Vran Upakrama        -      Ksharvarti & Ksharpichu Technique       -       Hemorrhoidectomy (Open N Close Method)       -      IRC(Infra Red Coagulation) for Hemorrhoids       -       PPH(Stapler Hemorrhoidectomy) For Hemorrhoids       -       HAL (Hemorrhoidal Artery Ligation) Technique       -       Barran Band Ligation For Hemorrhoids       -      Kshar Karma(Chemical Cauterization) for Hemorrhoids       -       Sclaro Therapy       -       Jalouka - Leach Application Technique       -       Crayo Surgery       -       Laser Surgery       -       Radio Frequency Cauterization       -       Basti Treatment (Medicated Enima For IBS & U Colitis)       -       Chemical Cutrization Through Ayurvedic Drugs       -       Conservative Managment - Shaman Chikitsa For Anorectal Diseases       -      Surgery According to Ayurveda       -       Surgery According to Modern Science       -      

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(*)-Compulsory Fields

The Assessment form for anal fistula (Fistula in Ano)

First Name*
:
    

Middle Name*

:

    

Last Name*

:

    
Date of Birth* :
   
Sex* :    
Occupation :
Address*
:
    
Country* :
State* :    
District* :    
City*
:
    
Pin / Zip Code
:
Tel No. *
:
+
Country Code Area Code Telephone
Mobile*
:
    
Email Address* :    
 
Please provide the following information as accurately as possible
Do you have an abscess / boil / opening / nodule in the perennial region?
   Yes   No   
Is there redness / soreness / inflammation at the site? (In the perennial region)
   Yes    No   
Is it painful when pus collects at the site?
   Yes No    
Does it burst intermittently? 
   Yes No    
Is there itching / purities at the site?
   Yes   No   
Are you suffering from any inflammatory bowel diseases?
   Yes No (If yes then Specify)    
Are you suffering from? *   
Recurrent dysentery
Diarrhea
Chronic anal fissure
Hemorrhoids/ Piles
Cancer (Malignancy)
Any other condition of the anus –rectum -colon
Yes No   
What type of treatment do you take to rectify it? *
Please provide details    
Bowel habits*   
Frequency
1 to 3 times
3 to 6 times
More then 6 times.
Consistency of Stool
Dry and hard
Soft but formed
Semisolid
Watery
Is the passage of stool associated with? *   
Bleeding
Mucous discharge
Pus discharge
Muco-purulant discharge
Abdominal pain
Do you experience a felling of not having evacuated your bowel completely even after passing stool?
    Yes No   
Are you suffering from Indigestion / Feeling of heaviness / blotted ness / in the abdomen?
    Yes No   
Abdomen discomfort & pain?
    Yes No    
Can you feel some mass (lymph glands) in the inguinal region?
    Yes No     
Have you lost weight recently?
    Yes No     
Do you have a present / previous history of tuberculosis?
    Yes No      
Have you carried out any investigation?
    Yes   No (If Yes then Select)      
Have you confirmed the diagnosis by getting your self examined by a Proctologist / Colo-rectal surgeon / General surgeon? (If Yes: If possible forward your surgeon remark / Notes / Opinion by attachment)
     Yes   No     
Have you carried out other investigation?
    Yes   No (If Yes then Specify)      
If you have been operated previously specify the condition of your anal sphincters
Control of Passage of stool     
Normal
Partial
Lost
Control of Passage of Flatus (air)      
Normal
Partial
Lost
Have you previously under gone any type of rectal surgery?
    Yes   No (If Yes then Specify Details)      
• Verification Code (*) :
Security Code
Enter the above code in the provided box
Note: Code is Case Sensitive
   

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