At Tulip Multi-Speciality Hospital, we continue to set new benchmarks in advanced gastrointestinal and anorectal care. Under the expert guidance of Dr. Kishore Kumar, a senior General Surgeon with over 15 years of experience, our team successfully treated a challenging case involving a chronic anal fissure with Grade III haemorrhoids and a rectal polyp.
The case was managed using a minimally invasive laser sphincterotomy, combined with hemorrhoidoplasty and a colonic punch biopsy, ensuring complete patient comfort and full recovery.
Our patient, Mr. Siddharth, a 21-year-old male, had been suffering from intermittent pain and bleeding during bowel movements for several months. With an accurate diagnosis, advanced laser treatment, and compassionate post-operative care, he achieved a smooth, pain-free, and complication-free recovery.
Understanding the Medical Conditions
What Are Anal Fissures?
An anal fissure is a small tear or cut in the lining of the anus, commonly caused by constipation or passing hard stools. When it becomes chronic, the wound struggles to heal and develops thickened edges, often requiring surgical intervention.
Common Symptoms Include:
• Sharp pain while passing stool
• Bleeding or streaks of blood on tissue paper
• Itching or burning around the anus
• Spasms of the anal sphincter muscle
What Are Haemorrhoids?
Haemorrhoids (piles) are swollen veins in the lower rectum or anus. They can be internal (inside the rectum) or external (under the skin near the anus).
In this case, the patient had Grade III haemorrhoids, which prolapse during bowel movements and need manual repositioning or surgical correction.
Common Causes Include:
• Chronic constipation or excessive straining
• Sedentary lifestyle
• Low-fibre diet
• Prolonged sitting
• Family history
Symptoms Include:
• Bleeding during bowel movements
• Pain or discomfort near the anus
• Swelling or protrusion from the anal canal
• Mucous discharge
What Is a Rectal Polyp?
A rectal polyp is an abnormal growth on the inner lining of the rectum. Most are benign, but some can be precancerous — hence, removal and histopathological examination (HPE) are important.
Possible Symptoms:
- Rectal bleeding
- Mucous discharge
- Feeling of incomplete evacuation
- Change in bowel habits
In this case, a small rectal polyp was detected during proctoscopy and removed via colonic punch biopsy.
Detailed Case Overview
Patient Name: Mr. Sidharth
Age/Sex: 21 / Male
Diagnosis:
• Chronic Anal Fissure
• Grade III Haemorrhoids
• Rectal Polyp
Procedure Performed:
Laser Sphincterotomy with Hemorrhoidoplasty and Colonic Punch Biopsy
Date of Surgery: 16.07.25
Consultant: Dr. Kishore Kumar, General Surgeon
History of Presenting Illness
Mr. Sidharth visited Tulip Multi-Speciality Hospital with complaints of painful bowel movements and intermittent rectal bleeding for several months. He also experienced occasional mucous discharge and haemorrhoid enlargement that needed manual reduction.
Despite trying conservative treatments like ointments, stool softeners, and dietary changes, his relief was only temporary. The constant discomfort began affecting his daily routine and emotional well-being — prompting him to seek expert surgical care.
He reported no fever, vomiting, or abdominal pain. Clinical evaluation revealed a chronic anal fissure, prolapsed Grade III haemorrhoids, and a small rectal polyp identified during proctoscopy.
Key Findings:
- Persistent fissure with fibrotic edges and a sentinel tag
- Engorged internal haemorrhoids requiring manual repositioning
- A small sessile rectal polyp on the posterior rectal wall
After multidisciplinary evaluation by the departments of General Surgery, Gastroenterology, and Anaesthesia, the team decided to proceed with single-session laser surgery to address all three conditions together.
Clinical Examination
• Conscious, alert, and cooperative
• Temperature: 98.4°F
• Pulse: 72/min
• BP: 140/80 mmHg
• SpO₂: 98% (room air)
• Weight: 71.1 kg
Systemic Examination:
• CVS: Normal heart sounds (S1, S2)
• RS: Bilateral air entry present
• P/A: Soft, non-tender abdomen
•CNS: No neurological deficit
Per rectal examination confirmed tenderness and Grade III haemorrhoids.
Diagnostic Evaluation
A complete diagnostic workup was done to ensure safe and precise surgical planning.
Investigations and Findings:
• Blood Tests (CBC, LFT, RFT): Normal
• Proctoscopy: Grade III haemorrhoids (3 & 7 o’clock), chronic fissure, and rectal polyp
• Digital Rectal Exam: Sphincter spasm and tenderness
• Preoperative Assessment: Normal cardiovascular and respiratory systems
• HPE: Benign rectal polyp — no malignancy detected
This thorough assessment ensured accurate diagnosis and minimized surgical risk.
Final Diagnosis:
Chronic Fissure with Grade III Haemorrhoids and Rectal Polyp
Surgical Procedure
Laser Sphincterotomy with Hemorrhoidoplasty and Colonic Punch Biopsy
Under spinal anaesthesia, the patient was placed in lithotomy position and aseptically prepared. Per-rectal and proctoscopic confirmations were done before proceeding.
Key Surgical Steps:
- Laser Sphincterotomy:
A diode laser was used to gently divide the internal sphincter muscle, reducing spasm and promoting fissure healing. - Laser Hemorrhoidoplasty:
Grade III haemorrhoids were treated using laser coagulation to shrink the swollen veins, restoring normal tissue without cuts or sutures. - Colonic Punch Biopsy:
The rectal polyp was removed and sent for histopathological analysis. - Hemostasis:
Achieved effectively with the laser — resulting in minimal bleeding and a short operative time.
Intraoperative Duration: 35–40 minutes
Blood Loss: Minimal
Complications: None
The surgery was completed smoothly and uneventfully.
Post-Operative Care and Recovery
Mr. Sidharth recovered quickly and comfortably after surgery. He was monitored closely for pain, bleeding, and bowel function.
Post-Surgery Care Plan:
• IV antibiotics and pain relief medications
• Sitz baths to promote hygiene and healing
• Stool softeners and a high-fibre diet
• Local antiseptic applications
• Early ambulation and proper hydration
• Continued care with antiseptic ointments
Recovery Milestones
• Day 1: Mild soreness, no bleeding, stable condition
• Day 2: Passed stool comfortably, minimal pain, started soft diet
• Day 3: Resumed normal diet, walked freely, pain reduced
• Day 5: Swelling subsided, resumed light activities
• Day 7: Wound healed well, pain-free defecation
• Day 10: Normal bowel habits, no need for painkillers
• Day 14: Biopsy confirmed benign polyp; asymptomatic
• Day 21: Complete mucosal healing, normal anal tone
• 1 Month: Fully back to daily routine, no recurrence
• 3 Months: Sustained healing, healthy mucosa, full recovery
Long-Term Outcome
At one month follow-up, Mr. Sidharth showed no recurrence of symptoms and resumed his normal lifestyle comfortably.
Discharge Instructions:
• Maintain a high-fibre diet
• Avoid straining or sitting for long periods
• Continue Sitz baths twice daily
• Attend follow-up after 10–14 days
Why Dr. Kishore Kumar’s Expertise Made the Difference
With over 15 years of surgical experience, Dr. Kishore Kumar is widely recognized for his skill in minimally invasive and laser-assisted gastrointestinal procedures. His patient-first approach focuses on comfort, safety, and lasting results.
Areas of Expertise:
• Gastrointestinal and Colorectal Surgeries
• Laparoscopic and Laser-Assisted Procedures
• Treatment of Piles, Fissures, and Fistulas
• Gallbladder, Appendix, and Hernia Surgeries
• Management of Gallbladder and Digestive Tract Disorders
• Minimal Access and Day-Care Surgeries
He ensures every patient understands their condition and takes an active role in their healing journey.
About Tulip Multi-Speciality Hospital
Tulip Multi-Speciality Hospital is a trusted centre for surgical and gastrointestinal excellence. Our hospital is equipped with modern laser technology, advanced operation theatres, and a dedicated post-operative care team, ensuring every patient’s safety and speedy recovery.
Our Facilities Include:
• 24/7 Emergency and Trauma Care
• Modern Laser Surgery for Piles and Fissures
• Laparoscopic and Minimal Access Surgery Units
• Expert Anaesthesia and Critical Care Teams
• Comprehensive Post-Surgery Rehabilitation
Each case is managed by a multidisciplinary team of surgeons, anaesthetists, dietitians, and nurses, providing complete and compassionate care.
Conclusion
Mr. Siddharth’s successful recovery from chronic fissure, Grade III haemorrhoids, and rectal polyp at Tulip Multi-Speciality Hospital highlights our hospital’s excellence in minimally invasive gastrointestinal surgery.
Through Dr. Kishore Kumar’s surgical expertise and our state-of-the-art facilities, his painful and recurring condition was completely resolved — restoring comfort, confidence, and quality of life.
At Tulip, we believe every patient deserves to live pain-free, where modern medicine meets compassionate care.
Frequently Asked Questions (FAQs)
- What causes chronic anal fissures and haemorrhoids?
Chronic constipation, straining during bowel movements, and low-fibre diets are common causes. Sedentary lifestyle and dehydration also contribute. - What is laser sphincterotomy, and how does it help?
Laser sphincterotomy is a minimally invasive procedure that relaxes the tight anal sphincter muscle, allowing chronic fissures to heal quickly and painlessly. - Are laser treatments better than traditional surgery?
Yes. Laser procedures cause minimal bleeding, faster healing, less post-operative pain, and quicker return to normal activities. - How long does it take to recover after laser hemorrhoidoplasty?
Most patients resume normal activities within 3–5 days, with complete recovery in 2–3 weeks. - Are rectal polyps dangerous?
Most polyps are benign, but some may become precancerous. A biopsy ensures early detection and treatment if needed. - What lifestyle changes help prevent recurrence?
Adopt a high-fibre diet, drink plenty of water, avoid straining, and maintain regular bowel habits.
