Fistula Study Form

Evaluation of Surgical Techniques and Outcomes in the Management of Complex Anal Fistulas: A Cohort Study

Patient Demographics

Patient ID / File No.

Age

Weight (kg)

Height (cm)

Sex

Male

Female

Disease Duration (days)

Etiology

Comorbidities & Preoperative Assessment

Comorbidities

T2DM

HTN

Other Comorbidities

Preoperative Assessment

US

MRI

Clinical Characteristics

External Openings

Single

Multiple

Radial Site

Anterior

Posterior

Distance from Anal Verge

<5cm

≥5cm

Horseshoe Fistula

Yes

No

Surgical Intervention

Surgical Technique

Seton Placement (Loose or Cutting)

LIFT Procedure

Endorectal / Mucosal Advancement Flap

Pain & Healing Outcome

Wound Healing Outcome

Cured

Failure

VAS Pain (1st Defecation)

5

VAS Pain (7 Days Post-Op)

5

VAS Pain (14 Days Post-Op)

5

Wexner & Postoperative Assessment

Pre-op Wexner Score

3-Month Wexner Score

6-Month Wexner Score

12-Month Wexner Score

Incision Scar Score

Hospital Stay (days)

Wound Healing Time (days)

Recurrence

Yes

No

Appearance of Anus

Normal

Deformed

Complications