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Background: Hemorrhoids are the most common anorectal disease. In Finger guided Hemorrhoidal Artery Ligation (FGHAL), the branches of Superior Hemorrhoidal Artery (SHA) are ligated after palpating the arteries with finger 2-3 cm above dentate line instead of using a doppler as in Doppler-guided Hemorrhoidal Artery Ligation (DGHAL). The procedure is followed by Laser Hemorrhoidoplasty (LHP), a minimally invasive technique. Methods: We conducted the study to retrospectively analyze the clinical outcomes of FGHAL with LHP for surgical management in a patient cohort with hemorrhoids in routine clinical practice. We retrospectively collected and analyzed the data from hospital records of patients treated with FGHAL with LHP for their hemorrhoid disease (HD) from March 2017– March 2020 to understand the impact on pain, bleeding, and resolution of symptoms. Results: The study included a total of 346 patients within 27 to 75 years of age. The presenting features were bleeding (93%), pain (89%), and prolapsed hemorrhoids (69%). Most patients had grade II hemorrhoids (60.7%). Patients reported no spontaneous bleeding after surgery; 225 patients (65%) experienced post-defecatory bleeding the day one after surgery and 98 patients (28.3%) on postoperative day 3. Patients did not report any bleeding after the 7th postoperative day. 90.2% had completely resolved symptoms 6-months after surgery. The average VAS score at 6h,12h,24h,48h and 72h after surgery were 3,2.2,1.3,0.4 and 0.1 respectively. Conclusion: FGHAL is a cost-effective alternative to DGHAL. FGHAL, followed by the LHP technique, provides a very low pain and discomfort with minimal need for analgesics and wound care, electing it among the procedures suitable for HD. The method is a cost-effective alternative to DGHAL.

This paper outlines the recommendations from the Association of Colon & Rectal Surgeons of India (ACRSI) practice guidelines for the management of haemorrhoids—2016. It includes diagnosis and management of haemorrhoids including dietary, non-surgical, and surgical techniques. These guidelines are intended for the use of general practitioners, general surgeons, colorectal surgeons, and gastrointestinal surgeons in India.

Fissure-in-ano is a tear in the skin around the distal anal canal below the level of the dentate line, overlying the lower half of the internal sphincter. It is characterized by pain at defecation, burning, itching, and streaks of fresh red blood over a hard stool. It is mainly managed by relaxing the anal sphincter in addition to the use of stool softeners, local anesthetic, and intake of high dietary fibers. Chemical sphincterotomy agents act as pain relievers by relaxing the internal sphincter and are available mainly in ointment forms including nitrates and calcium channel blockers. Besides these, surgical treatment is intended in the patients who fail to respond by other methods. The surgical methods include Internal sphincterotomy, Fissurectomy, Lord's procedure, and other such methods, which are discussed briefly in this article.