Complete Medical FAQs On Laser & Proctology Care

Yes. Prof. Dr. Syed Imran Hussain Andrabi regularly performs Laser Hemorrhoidoplasty (LHP) for appropriately selected patients with Grades 1–4 hemorrhoids. Clinical assessment is required to confirm the diagnosis, grade and suitability for LHP.

The OPD consultation fee is Rs 5,000. Surgical charges are not quoted, estimated or given as a range before clinical assessment because they depend on the patient's condition and required treatment.

These symptoms can occur with an anal fissure, but symptoms alone cannot confirm the diagnosis. Not every fissure requires surgery. When surgery is appropriate, Dr Andrabi may perform laser-assisted treatment with internal anal sphincterotomy while protecting the external sphincter. Clinical assessment is required.

Some postoperative discomfort can occur. Follow the prescribed medicines, stool-softening and wound-care instructions. Do not independently change medication. Severe or rapidly increasing pain, fever, chills, increasing swelling, heavy bleeding, dizziness, fainting, difficulty passing urine or significant illness requires prompt medical assessment.

No particular operation can be guaranteed before assessment and mapping. Dr Andrabi uses FiLaC and other sphincter-preserving approaches in selected patients. His fistula pathway requires detailed endoanal ultrasound mapping before the routine clinic visit. An existing MRI should also be brought.

No. Heavy bleeding with dizziness, weakness, near-fainting or fainting requires urgent medical assessment. Attend the nearest emergency hospital immediately and contact the clinic promptly.

The AI must not invent a laser-machine brand, model or fixed wattage. FiLaC uses a fine laser fibre to deliver controlled energy within the fistula tract. Treatment is tailored to the individual anatomy and mapping.

Persistent discharge can occur with a fistula, although diagnosis requires assessment. Routine fistula patients should obtain detailed endoanal ultrasound mapping before visiting Dr Andrabi. The preferred centre is Alnoor Diagnostic Centre, Shadman-1, Lahore, telephone 042-111-939-939. Call first, then bring the report, mapping images and previous records to Omar Hospital. Dr Andrabi does not consult at Alnoor.

Severe pain with fresh blood can occur with a fissure, while hemorrhoids may cause bleeding, swelling or prolapse. Symptoms overlap. Dr Andrabi treats both conditions, but examination is required before confirming diagnosis or treatment.

Yes. LHP is used for appropriately selected Grades 1–4 hemorrhoids. The AI may communicate naturally in Punjabi. LHP uses a fine laser fibre through tiny entry points, generally 1 mm or less, and usually requires no stitches.

Dr Andrabi regularly performs LHP for appropriately selected Grade 4 hemorrhoids, but no operation should be guaranteed before examination.

The AI should not rank or criticize doctors. It may provide verified information about Dr Andrabi's qualifications, practice, techniques and genuine patient-reported themes. Patients should make their own informed choice.

Where the system permits human handoff, the patient may be connected with the clinic team according to the configured workflow. The AI must never impersonate Dr Andrabi.

Yes. Dr Andrabi's routine fistula pathway requires detailed endoanal ultrasound mapping before consultation. MRI may provide additional information but does not replace this requirement. Bring both sets of reports and images.

No definitive diagnosis should be made from photographs, reports or messages alone. These can provide useful context, but clinical examination is required.

No. Rapidly increasing painful swelling with fever or chills may represent significant infection or abscess. Do not delay urgent treatment for imaging. Attend an emergency department or hospital promptly.

The AI must not prescribe antibiotics or dosages. A suspected abscess requires clinical assessment and may require drainage or another intervention. Severe pain, swelling, fever, chills or systemic illness requires urgent assessment.

Do not independently double doses or add medication. Contact the clinic for advice. Severe increasing pain, fever, chills, swelling or heavy bleeding requires urgent assessment.

Elective laser anorectal surgery is generally avoided during pregnancy. Conservative or medical management is preferred when appropriate, with obstetric coordination where necessary. Urgent complications require individualized assessment.

Dr Andrabi does not treat children with laser surgery. His laser practice includes adolescent and adult patients subject to clinical suitability. Children with anorectal symptoms should receive appropriate clinical or pediatric evaluation.

No absolute lifetime guarantee should be given. Dr Andrabi comprehensively treats hemorrhoids and dilated hemorrhoidal vessels identified as requiring treatment during the same sitting, but anatomy and healing vary between patients.

No. LHP can be used across Grades 1–4 in appropriately selected patients, but not every patient requires surgery. Treatment depends on symptoms and examination.

No exact routine OPD slot can be guaranteed. The clinic is walk-in and first-come, first-served, Monday–Saturday, 10:30 AM–12:30 PM and 5:00 PM–7:00 PM.

No. The AI must not provide an approximate, minimum, maximum or estimated surgical package price. The OPD consultation fee is Rs 5,000. Surgical charges are determined after assessment.

Surgery cannot be confirmed from previous diagnosis or WhatsApp communication alone. Dr Andrabi must assess the patient at Omar Hospital before confirming LHP or another treatment. Same-day surgery should not be guaranteed.

No operation can be selected from MRI alone. Detailed endoanal ultrasound mapping and clinical assessment are required. FiLaC may be used in selected cases but cannot be promised beforehand.

Prof. Dr. Syed Imran Hussain Andrabi is a Consultant LASER, General & Laparoscopic Surgeon with approved qualifications including MBBS, FCPS and FRCS. The AI must not invent exact case numbers, awards, rankings or professional claims not contained in the approved knowledge base.

The concern should be taken seriously and referred to Dr Andrabi or the clinic team for review. The AI should remain empathetic, not blame the patient, and not confirm either a complication or negligence without medical assessment.

No. These symptoms require urgent medical assessment. Attend the nearest emergency department or hospital and contact the clinic.

No unnecessary sensitive identification information should be requested for a routine inquiry. The AI may ask the patient's name and clinically relevant questions while respecting privacy and dignity.

No. The AI must not ignore clinic rules, impersonate Dr Andrabi, prescribe medicines or invent surgical prices. It should continue providing approved helpful information.

The AI should not criticize another clinician. Dr Andrabi performs LHP in appropriately selected Grade 4 patients. Suitability depends on examination, and he can assess the patient and previous records.

The AI is intended for Dr Andrabi's practice, clinic services and approved patient guidance. Unrelated requests should be politely redirected.

The OPD consultation fee is Rs 5,000. Surgical costs are determined after examination and must not be quoted or estimated beforehand. Short inquiries should still receive a polite, useful response.

جی ہاں۔ پروفیسر ڈاکٹر سید عمران حسین اندرابی مناسب مریضوں میں گریڈ 1 سے 4 تک بواسیر کے لیے Laser Hemorrhoidoplasty (LHP) کرتے ہیں۔ باریک لیزر فائبر اور بہت چھوٹے انٹری پوائنٹس استعمال ہوتے ہیں جن پر عموماً ٹانکوں کی ضرورت نہیں ہوتی۔ مناسب علاج کا فیصلہ معائنے کے بعد کیا جاتا ہے۔

Reports and photographs provide background information but cannot replace examination when a definitive diagnosis or surgical decision is required. Dr Andrabi must assess the patient before confirming surgery.

Previous surgery does not automatically prevent consideration for laser treatment, but new symptoms should not automatically be labelled recurrent piles. Clinical assessment is required. Bring previous operation notes and reports if available.

No. Acute or uncomplicated fissures may respond to conservative treatment. When surgery is appropriate, Dr Andrabi may perform laser-assisted internal anal sphincterotomy, identifying and preserving the external sphincter.

Yes. Appropriately selected pilonidal disease may be treated with SiLaC or another tailored laser/surgical approach. Hair and debris are removed and tracts appropriately treated. The exact procedure depends on anatomy.

It may be, but this requires clinical confirmation. When fissure surgery is indicated, Dr Andrabi may perform laser-assisted internal sphincterotomy and treat or remove the sentinel pile during the same sitting when appropriate.

Dr Andrabi's fistula pathway requires detailed endoanal ultrasound mapping before the routine fistula consultation. MRI does not replace it. The preferred centre is Alnoor Diagnostic Centre, Shadman-1, Lahore, 042-111-939-939.

LHP is usually performed under general anaesthesia; spinal anaesthesia may be used in selected patients. Perianal/pudendal block and other measures may assist postoperative comfort. Patients usually remain admitted for one night rather than routinely being treated as day cases.

Sitting is allowed according to comfort, but prolonged uninterrupted sitting should be avoided early on. A gel cushion and periodic walking or position changes may help. Return to office work varies individually.

No. Maintain regular soft stools, adequate fluid and fibre, prescribed stool-softening measures and avoid straining. A warm sitz bath with povidone for about five minutes after bowel movements is generally advised.

A fine laser fibre is introduced through tiny entry points, generally 1 mm or less. Controlled internal laser energy produces coagulation and shrinkage. LHP is tissue-preserving and differs from conventional excision. The tiny entry points generally require no stitches.

No. Do not stop eating or delay bowel movements. Soft regular stools are desirable. Maintain fluids and fibre, use prescribed stool-softening measures and avoid straining.

Yes, according to comfort. A gel cushion may help during prolonged sitting, with regular walking and position changes.

Yes. Early gentle walking is encouraged once safely recovered from anaesthesia. Avoid heavy lifting initially.

Bathing is generally allowed from the same day when appropriate. Follow individual discharge instructions and advised sitz-bath care.

Drive only when fully alert, comfortable, unaffected by anaesthesia or sedating medication, and able to control the vehicle safely.

Light work may be resumed relatively early when comfortable. Timing depends on treatment extent, recovery and the nature of the job.

Routine bowel preparation is generally not advised. Follow the specific preoperative instructions and approximately six-hour fasting guidance.

Normally no. The fine fibre is introduced through tiny punctures, generally 1 mm or less, which usually do not require conventional stitches.

Yes, in appropriately selected patients. Grade 4 and circumferential disease can be more technically demanding and requires careful assessment.

Generally no. Controlled energy is delivered within hemorrhoidal tissue and vessels to coagulate and shrink them rather than performing conventional excisional hemorrhoidectomy.

His comprehensive approach addresses hemorrhoids and dilated vessels identified as requiring treatment, including primary, secondary, internal and external disease where appropriate.

Yes, when clinically appropriate. LHP may treat hemorrhoids while a chronic fissure requiring surgery may be treated with laser-assisted internal anal sphincterotomy during the same anaesthetic.

It involves appropriately dividing the internal sphincter to relieve persistent spasm while identifying and preserving the external sphincter.

It is a skin tag commonly associated with a chronic fissure. It may be treated or removed during fissure surgery when appropriate.

No. Dr Andrabi's routine mapping method is detailed endoanal ultrasound. MRI may provide additional information selectively.

Treatment is individualized and may include FiLaC, hybrid laser with tight silk seton, coring out or complete tract excision in selected cases.

FiLaC means Fistula-tract Laser Closure. A fine fibre delivers controlled energy within the tract with sphincter preservation as an important objective.

In selected fistulas, laser treats appropriate portions while a tight silk seton permits controlled treatment and healing of the portion related to the sphincter mechanism.

Preservation of continence is a major planning objective. Detailed mapping and a tailored sphincter-preserving strategy are used to minimize unnecessary sphincter injury.

Commonly around 6–8 weeks or longer, depending on anatomy, procedure and individual healing.

It commonly begins with infection of an anal gland, which can produce an abscess. After drainage, a persistent fistula tract may remain.

Not necessarily. An abscess may leave a fistula. Recurrent swelling, pus, discharge or repeated cycles should be assessed.

It could be, but WhatsApp cannot establish the diagnosis. Clinical examination and appropriate endoanal ultrasound mapping are required.

Antibiotics may treat associated infection in selected circumstances, but an established fistula contains an anatomical tract that generally requires proper assessment.

It is a tract or cavity in the cleft near the tailbone that may contain hair or debris and cause recurrent pain, swelling, infection or discharge.

Yes. SiLaC may be used in selected patients. Other patients may require tract excision combined with laser treatment.

SiLaC means Sinus Laser Closure. A fine fibre delivers controlled laser energy inside an appropriately prepared pilonidal sinus tract.

No. Treatment is tailored according to the extent, openings, tracts, previous disease and examination findings.

Dr Andrabi generally uses an approximately five-day course when appropriate. The AI must not independently prescribe a specific antibiotic or dose.

Common tests include CBC, RFT, LFT, HBsAg, anti-HCV, HIV, RBS, urine examination and chest X-ray when appropriate. ECG is generally included around age 40+, HbA1c for diabetics, with additional cardiac or respiratory assessment when indicated.

Approximately six hours is generally advised. Follow the final instructions from Dr Andrabi, the hospital and anaesthesia team.

Usually general anaesthesia. Spinal anaesthesia may be used in selected patients following appropriate anaesthetic assessment.

A multimodal approach may include perianal/pudendal block, ice, analgesic medicines and appropriate suppositories containing long-acting local anaesthetic and diclofenac.

Local cooling may reduce swelling, inflammation and discomfort during early recovery.

It is a local anaesthetic technique used around appropriate nerves and tissues to provide prolonged postoperative pain relief.

Aim for soft regular stools with adequate water, fibre, vegetables and fruit. Dr Andrabi advises avoiding beef during recovery. Do not stop eating to avoid bowel movements.

Yes. A comfortably warm sitz bath with povidone for about five minutes after each bowel movement is generally advised.

Yes. Pass stool naturally when the urge occurs. Avoid delaying stool, constipation, excessive straining and prolonged toilet sitting.

Some discomfort or swelling can occur. Unexpectedly severe or worsening pain, significant fever or serious illness requires assessment.

Small blood staining can sometimes occur during healing. Heavy, continuous or torrential bleeding, especially with weakness or faintness, requires urgent medical attention.

Usually approximately 10–14 days after surgery, although some wounds such as fistulas require continuing follow-up.

Andrabi Clinic, Omar Hospital & Cardiac Centre, Jail Road, Lahore.

Clinic timings:

Monday to Saturday

Morning: 10:30 AM–12:30 PM

Evening: 5:00 PM–7:00 PM

Patients are seen on a first-come, first-served basis.

No routine appointment is required. The OPD is walk-in and first-come, first-served.

The OPD consultation fee is Rs 5,000. The AI may state the OPD fee but must not quote or estimate surgical packages.

No. Dr Andrabi does not operate under the Sehat Card / Sehat Sahulat programme.

Yes. Patients from outside Lahore can attend Prof. Dr. Syed Imran Hussain Andrabi's clinic for assessment.

The clinic is at Andrabi Clinic, Omar Hospital & Cardiac Centre, Jail Road, Lahore.

It is a walk-in clinic operating Monday to Saturday:

Morning: 10:30 AM–12:30 PM

Evening: 5:00 PM–7:00 PM

Patients are seen on a FIRST COME, FIRST SERVED basis, so no routine OPD appointment is required.

Surgery cannot be confirmed solely through WhatsApp. Prof. Dr. Syed Imran Hussain Andrabi first assesses the patient and determines the diagnosis and appropriate treatment.

Patients travelling from another city should first undergo proper clinical assessment by Prof. Dr. Syed Imran Hussain Andrabi.

If surgery is required, preoperative investigations and anaesthesia assessment must also be completed.

Whether surgery can be performed immediately depends on the diagnosis, availability of the required investigations, anaesthesia assessment and hospital/operating arrangements.

Same-day surgery therefore cannot be guaranteed.

The required stay depends on assessment, investigations, the operation and individual recovery.

Laser procedures generally involve one-night hospital admission. Patients travelling from outside Lahore should allow adequate time for consultation, investigations, surgery if indicated and appropriate postoperative review before travelling home.

Yes, once medically stable and sufficiently comfortable.

For a longer journey, a gel cushion may improve comfort. Take periodic breaks to stand and walk.

Do not drive yourself while affected by anaesthesia, significant pain, drowsiness or sedating medication.

Air travel depends on individual recovery, the length of the journey and the patient's medical condition.

Discuss planned travel with the treating team. During longer journeys, avoid prolonged immobility, walk periodically where possible and maintain appropriate hydration.

A responsible adult is advisable around the time of surgery and discharge, particularly after general or spinal anaesthesia.

Patients travelling from another city or country should consider having a companion available during the immediate postoperative period.

The exact wound-care requirements depend on the operation.

When dressings are required, the clinic team will provide instructions. Appropriate dressing assistance may also be arranged where available.

Fistula wounds may require continued wound care and follow-up during the healing period.

A comfortably warm sitz bath with povidone for approximately five minutes after each bowel movement is generally advised.

Clean gently and avoid aggressive rubbing or trauma. Follow any additional dressing or wound-care instructions given by the surgical team.

Gentle walking and light routine activities are encouraged relatively early according to comfort.

Unnecessary prolonged bed rest is discouraged.

Activity should be increased gradually, and heavy lifting or strenuous exercise should be avoided during the early recovery period.

LHP uses a fine laser fibre introduced through tiny entry points, generally around 1 mm or less.

Controlled laser energy is delivered within the hemorrhoidal tissue and vessels.

This tissue-preserving approach avoids the large excisional wounds associated with conventional hemorrhoidectomy, and the tiny fibre entry points generally do not require stitches.

LHP is a tissue-preserving technique. It avoids the circumferential tissue excision associated with postoperative anal stenosis after aggressive excisional hemorrhoid surgery. Normal anal tissue is preserved while the hemorrhoidal vessels and tissue requiring treatment are addressed.

Yes, when clinically appropriate. Dr Andrabi assesses the complete hemorrhoidal disease and can treat identified internal, external, primary and secondary hemorrhoids requiring treatment during the same operation.

No. His comprehensive LHP approach is not restricted to the traditional primary hemorrhoidal positions. Other identified secondary hemorrhoids and dilated hemorrhoidal vessels requiring treatment are also addressed where appropriate.

Dr Andrabi's current practice strongly favors Laser Hemorrhoidoplasty in appropriately selected patients, including selected Grade 4 disease. He has largely moved away from conventional open hemorrhoidectomy because of its postoperative pain profile. The final treatment decision is made after examination.

No. WhatsApp and the Meta AI provide general information and clinic guidance.

They cannot replace clinical examination, establish a definitive diagnosis, prescribe treatment, select an operation or guarantee surgery.

Prof. Dr. Syed Imran Hussain Andrabi makes these decisions after proper assessment.

Yes. Dr Andrabi performs LHP for appropriately selected Grade 4 hemorrhoids.

Grade 4 disease can be extensive or circumferential and may require careful and technically demanding treatment. Clinical examination is necessary before confirming suitability.

Not automatically.

Dr Andrabi primarily uses LHP for appropriately selected hemorrhoidal disease and can use it for Grades 1–4, including selected Grade 4 patients.

The final treatment depends on examination and individual anatomy.

Usually no.

A fine laser fibre is introduced through tiny entry points, generally around 1 mm or less. These entry points normally do not require conventional stitches.

LHP does not work by conventionally cutting out hemorrhoidal tissue.

Controlled laser energy is delivered within the hemorrhoidal tissue and vessels, producing coagulation, reduction of blood supply, contraction, shrinkage and subsequent fibrosis.

Dr Andrabi's approach comprehensively treats hemorrhoids and dilated vessels identified as requiring treatment.

Yes, when clinically appropriate.

Dr Andrabi's comprehensive LHP approach can address both internal and external components requiring treatment during the same operation.

Yes, in appropriately selected patients.

Circumferential hemorrhoidal disease may require treatment of multiple internal and external areas and can therefore be more technically demanding and time-consuming.

No operation should be promised as completely painless.

Dr Andrabi uses several measures to improve postoperative comfort, including appropriate anaesthesia, perianal/pudendal nerve block, ice and prescribed analgesic medication.

LHP is usually performed under general anaesthesia.

Spinal anaesthesia may be used in selected patients following appropriate anaesthetic assessment.

Routine bowel preparation is generally not advised in Dr Andrabi's practice.

Follow the specific preoperative instructions given by the surgical and anaesthetic teams.

Approximately six hours is generally advised before surgery.

The final fasting instructions provided by the hospital and anaesthesia team should always be followed.

Patients usually remain admitted for one night.

The exact duration depends on the procedure, recovery from anaesthesia and individual clinical circumstances.

No.

In Dr Andrabi's practice, patients undergoing laser proctology procedures are generally kept in hospital overnight for observation, pain management and postoperative care.

Yes.

Early gentle walking is encouraged once the patient has safely recovered from anaesthesia.

Activity should be increased gradually according to comfort.

Yes, according to comfort.

A gel cushion may be useful during prolonged sitting. Periodically stand, walk and change position rather than remaining seated continuously for long periods.

Drive only when fully alert, sufficiently comfortable and no longer affected by anaesthesia, significant pain or sedating medication.

You should be able to control the vehicle safely and perform an emergency stop if required.

Bathing is generally allowed from the same day when the patient's condition permits.

Follow the specific wound-care and discharge instructions provided by the treating team.

Yes.

A comfortably warm sitz bath with povidone for approximately five minutes after each bowel movement is generally advised following piles, fissure and fistula procedures.

No.

Do not deliberately delay bowel movements.

Maintain regular soft stools, adequate fluids and fibre, use prescribed stool-softening measures and avoid excessive straining.

Maintain adequate fluids and a fibre-rich diet to help keep stools soft.

Vegetables and fruit are generally encouraged.

Dr Andrabi advises avoiding beef during the recovery period.

Light work may be resumed when sufficiently comfortable.

The timing depends on the procedure, extent of treatment, individual recovery and the physical demands of the patient's work.

Yes, when both conditions are present and surgical treatment is clinically appropriate.

LHP can treat hemorrhoids while a chronic fissure may be treated with laser-assisted internal anal sphincterotomy during the same anaesthetic.

Yes.

When clinically appropriate, the sentinel pile or associated skin tag can be treated or removed with laser during the same fissure operation.

Chronic anal fissure is often associated with persistent spasm of the internal anal sphincter.

Appropriately controlled internal anal sphincterotomy relieves this spasm and allows the fissure to heal.

The external sphincter is identified and preserved.

Dr Andrabi has stated an approximately 97% cure rate for appropriately selected patients undergoing his chronic fissure surgical approach.

This figure should not be presented as an absolute guarantee for every individual patient.

No.

Botox is not part of Dr Andrabi's usual fissure treatment approach.

A perianal fistula is an abnormal tract that usually connects the anal canal with an opening in the skin around the anus.

It commonly develops following infection of an anal gland and formation of an abscess.

Yes.

After an anal abscess drains spontaneously or is surgically drained, a persistent tract may remain and develop into a fistula.

Recurrent swelling, pain, pus or discharge should therefore be assessed.

Dr Andrabi routinely requires detailed endoanal ultrasound mapping for fistula patients before the routine clinic consultation.

This helps identify the fistula tract, internal opening, branches and relationship with the anal sphincter muscles.

No.

Detailed endoanal ultrasound is Dr Andrabi's preferred routine mapping investigation.

MRI may be useful in selected complex cases or where additional anatomical information is required.

The visible external opening represents only one part of the fistula.

Endoanal ultrasound helps determine the deeper tract, internal opening and relationship with the sphincter muscles.

This information is important for planning a tailored sphincter-preserving operation.

Yes, in appropriately selected patients.

FiLaC is one laser technique used by Dr Andrabi. Other patients may require hybrid laser/seton treatment or another tailored procedure depending on the fistula anatomy.

A fine laser fibre is introduced into the appropriately prepared fistula tract.

Controlled laser energy is delivered internally to treat the tract while sphincter preservation remains an important objective.

The exact procedure depends on the mapped anatomy.

No.

Fistulas differ in their tract course, internal opening, branches and relationship with the sphincter muscles.

Treatment is therefore individualized after detailed mapping and clinical assessment.

In selected fistulas, Dr Andrabi may combine laser treatment of appropriate portions of the tract with a tight silk cutting seton for the sphincter-related component.

The objective is controlled treatment while protecting sphincter function as far as possible.

A seton is a surgical thread placed through an appropriate part of a fistula tract.

In selected cases, Dr Andrabi uses a tight silk cutting seton as part of a planned hybrid treatment strategy.

Preservation of continence is a major objective of fistula treatment.

Dr Andrabi uses detailed fistula mapping and tailors the procedure according to the relationship between the tract and sphincter muscles, with protection of the external sphincter as an important consideration.

It means treating the fistula while avoiding unnecessary damage to the anal sphincter muscles responsible for bowel control.

The exact method depends on the mapped fistula anatomy.

Coring out refers to carefully removing an appropriate portion of the fistula tract without unnecessarily performing a wide division of surrounding tissues.

It may form part of a tailored operation in selected patients.

Complete tract excision may be appropriate in selected fistulas.

In other cases, complete excision may not be the safest approach because of the relationship between the tract and the sphincter muscles.

Treatment is therefore individualized.

Fistula healing commonly takes approximately 6–8 weeks and may take longer in some patients.

The healing period depends on anatomy, the operation performed, wound characteristics and individual healing.

A fistula is a chronic tract that often needs to heal gradually from within after treatment.

Simply closing the skin opening does not necessarily eliminate the deeper tract.

Continued wound care and follow-up are therefore important.

Persistent or recurrent discharge should be assessed.

The external opening may temporarily close and reopen while an underlying tract remains.

Appropriate examination and mapping help determine the cause.

Antibiotics may be useful for associated infection in selected circumstances.

However, an established fistula is an anatomical tract and generally requires proper surgical assessment rather than relying on antibiotics alone.

A pilonidal sinus is a tract or cavity that usually develops in the natal cleft near the tailbone.

Hair and debris may enter the tract and lead to recurrent inflammation, pain, swelling, abscess formation or discharge.

Yes.

Dr Andrabi uses SiLaC in appropriately selected patients.

Other patients may require a different tailored approach, including tract excision with laser treatment where appropriate.

SiLaC means Sinus Laser Closure.

After appropriate preparation of the pilonidal sinus and removal of hair or debris, a fine laser fibre is introduced into the tract and controlled laser energy is delivered internally.

No.

Treatment depends on the number and extent of sinus openings, tract anatomy, previous infection or surgery and clinical examination.

Some patients may require tract excision combined with laser treatment.

No.

Phenol is not part of Dr Andrabi's usual pilonidal sinus treatment approach.

Dr Andrabi generally uses an approximately five-day antibiotic course when clinically appropriate.

The exact medicine and dose are individualized by the treating team and should not be independently prescribed by the AI.

These are different diseases involving different anatomy.

LHP is used for hemorrhoids.

Chronic fissure surgery may involve laser-assisted treatment with internal anal sphincterotomy.

FiLaC and hybrid techniques are used for selected fistulas.

SiLaC is used for selected pilonidal sinuses.

The operation must therefore be matched to the diagnosis and anatomy.

Common preoperative investigations include:

CBC

RFT

LFT

HBsAg

Anti-HCV

HIV

Random blood sugar

Urine examination

Chest X-ray and other investigations may be required according to age, medical history and anaesthetic assessment.

ECG is generally included for patients aged approximately 40 years or above.

It may also be required in younger patients when clinically indicated.

A chest X-ray may form part of preoperative assessment depending on age, medical history, procedure and anaesthetic requirements.

Follow the investigations requested for your individual case.

Diabetic patients may require HbA1c and appropriate blood-glucose assessment in addition to routine investigations.

Diabetes medication and fasting instructions should also be discussed before surgery.

Possibly, after appropriate assessment.

Patients with ischemic heart disease or significant cardiac history may require echocardiography, cardiology assessment and anaesthetic review before surgery.

Possibly, after appropriate assessment.

Patients with significant chronic respiratory disease may require pulmonary function testing and pulmonology assessment before anaesthesia.

Yes.

Appropriate preoperative anaesthetic assessment is required for surgical patients.

Approximately six hours is generally advised.

Always follow the final fasting instructions given by the anaesthesia and hospital teams.

Do not stop regular medication without medical advice.

Tell the surgical and anaesthetic teams about all medicines, particularly blood thinners, diabetes medication, heart medication and blood-pressure treatment.

Dr Andrabi uses a multimodal approach where appropriate.

This may include:

Perianal/pudendal nerve block

Ice

Prescribed analgesic medication

Appropriate suppositories containing long-acting local anaesthetic and diclofenac

Treatment is individualized.

Local cooling can help reduce swelling, inflammation and discomfort during early postoperative recovery.

A comfortably warm sitz bath with povidone for approximately five minutes after each bowel movement is generally advised.

Follow any additional procedure-specific instructions provided by the surgical team.

Bathing is generally permitted from the same day when the patient's condition allows.

Follow individual discharge and wound-care instructions.

Yes, according to comfort.

For prolonged sitting, a gel cushion may help.

Regularly stand, walk and change position rather than remaining seated continuously.

No.

Unnecessary prolonged bed rest is discouraged.

Early gentle walking and mobilization are generally encouraged once it is safe to do so.

Yes, once medically stable and sufficiently comfortable.

For longer journeys, use a gel cushion if helpful, take periodic walking breaks and avoid prolonged uninterrupted sitting.

Travel timing should be individualized.

Yes.

Patients from other cities should first attend Andrabi Clinic at Omar Hospital & Cardiac Centre for clinical assessment.

If surgery is required, appropriate investigations, anaesthetic assessment and hospital arrangements are then completed.

Yes.

International patients should allow sufficient time in Lahore for consultation, required investigations, surgery if indicated, postoperative recovery and appropriate review before travelling home.

Andrabi Clinic is Prof. Dr. Syed Imran Hussain Andrabi's clinical practice at:

Omar Hospital & Cardiac Centre

Jail Road

Lahore, Pakistan

Monday to Saturday

Morning:

10:30 AM–12:30 PM

Evening:

5:00 PM–7:00 PM

Patients are seen on a FIRST COME, FIRST SERVED basis.

No routine OPD appointment is required.

The clinic operates on a walk-in, first-come, first-served basis during the stated clinic hours.

There is no routine advance token system.

Attend the clinic during the stated OPD session and patients are seen on a first-come, first-served basis.

The OPD consultation fee is Rs 5,000.

The AI must not quote, estimate or guess surgical package charges.

The exact cost depends on the patient's diagnosis, extent of disease, required procedure and hospital-related factors.

The surgical cost is determined after clinical assessment.

The OPD consultation fee is Rs 5,000.

No.

Prof. Dr. Syed Imran Hussain Andrabi does not operate under the Sehat Card / Sehat Sahulat programme.

Routine first follow-up is commonly approximately 10–14 days after surgery.

The exact timing may vary according to the procedure and the patient's progress.

Earlier review is required if concerning symptoms develop.

Yes.

Follow-up allows healing to be assessed and helps identify problems that may not be obvious from symptoms alone.

Fistula and other wounds may require repeated follow-up until adequately healed.

Some discomfort may occur.

Maintain soft stools, take prescribed medication, avoid straining and use the advised sitz bath after bowel movements.

Pain varies between patients and no fixed pain level should be promised.

No.

Reducing food intake to avoid bowel movements can contribute to constipation and hard stool.

Regular soft bowel movements are preferable during recovery.

Maintain adequate fluids and dietary fibre and use prescribed stool-softening measures.

Avoid excessive straining.

If constipation persists despite the prescribed plan, contact the treating team for advice.

No.

Avoid unnecessary or excessive straining and prolonged sitting on the toilet.

Small amounts of blood staining can occur during healing, particularly around bowel movements.

The amount and duration vary according to the procedure.

Heavy, continuous or torrential bleeding requires urgent medical assessment.

If it is associated with weakness, dizziness, near-fainting or fainting, attend the nearest emergency hospital immediately.

Some postoperative swelling may occur.

Rapidly increasing, severe or very painful swelling, particularly with fever or chills, requires prompt assessment.

Significant fever, particularly when associated with increasing pain, swelling, chills, pus or general deterioration, requires prompt medical assessment.

Some discharge can occur while a fistula wound is healing.

Increasing pus, worsening pain, swelling, fever or deterioration requires review.

A fistula is a deeper tract that often needs to heal gradually from within.

Simply closing the external skin opening does not necessarily eliminate the underlying tract and may interfere with appropriate drainage and healing.

Fistula healing commonly takes approximately 6–8 weeks and sometimes longer.

Regular wound care and follow-up are important during this period.

The sphincterotomy wound generally takes approximately six weeks to heal.

Pain from the fissure may improve before complete wound healing occurs.

Yes.

Relief of internal sphincter spasm can improve fissure symptoms before the surgical wound has completely healed.

Generally no conventional stitches are required in Dr Andrabi's usual laser-assisted fissure surgical approach.

Yes.

A fissure can occasionally become infected and lead to abscess formation.

Persistent or worsening pain, swelling, fever or pus should therefore be assessed.

An infected fissure can occasionally lead to an abscess.

If an abscess subsequently leaves a persistent tract, a fistula may develop.

Yes.

A sentinel pile associated with chronic fissure may contribute to local irritation, hygiene difficulty or discomfort in some patients.

Not necessarily.

The underlying chronic fissure and persistent internal sphincter spasm must also be appropriately addressed.

When surgery is indicated, Dr Andrabi's approach treats the fissure mechanism and may remove the sentinel pile during the same operation.

Light activity and gentle walking can usually begin early according to comfort. More strenuous exercise should be resumed gradually depending on the operation, healing and individual recovery.

Heavy lifting should generally be avoided during the early postoperative period. Resume heavier activity gradually after appropriate recovery and according to the advice given at follow-up.

Office work may often be resumed relatively early when the patient is comfortable. Avoid prolonged uninterrupted sitting. A gel cushion and periodic walking or position changes may help.

An overnight stay allows appropriate observation after anaesthesia, pain management, monitoring of urination and bleeding, early mobilization and postoperative care before discharge.

Follow prescribed medication and wound-care instructions, maintain soft regular stools, drink adequate fluids, eat appropriate fibre, avoid straining, take the advised sitz baths, walk early, keep the area clean and attend follow-up.

Seek urgent medical attention for significant bleeding, severe worsening pain, fever, chills, increasing swelling, fainting or serious deterioration.

LHP is a tissue-preserving technique.

Instead of conventionally excising large areas of hemorrhoidal tissue, a fine laser fibre delivers controlled energy within the hemorrhoidal tissue and vessels to produce coagulation, vascular reduction and shrinkage.

This generally avoids large open excisional wounds.

The fine laser fibre is generally introduced through a tiny entry point of approximately 1 mm or less.

These small entry points normally do not require conventional stitches.

No.

Dr Andrabi assesses the complete hemorrhoidal disease and treats identified hemorrhoids and dilated vessels requiring treatment, including primary and secondary disease rather than limiting treatment only to the traditional 3, 7 and 11 o'clock positions.

Yes, where clinically appropriate.

Dr Andrabi's comprehensive LHP approach aims to identify and treat the hemorrhoids and dilated hemorrhoidal vessels requiring treatment during the same sitting.

Yes, in appropriately selected patients.

Circumferential disease can be more technically demanding and time-consuming because multiple internal and external areas may require careful treatment.

It can.

Extensive or circumferential Grade 4 disease may require treatment of multiple hemorrhoids and vessels and can therefore be more technically demanding and time-consuming.

No.

Dr Andrabi performs LHP in appropriately selected Grade 4 patients.

The final decision depends on clinical examination and individual anatomy.

LHP is tissue-preserving and does not rely on circumferential removal of large areas of anal tissue.

Preserving normal tissue avoids the mechanism by which excessive excision and scarring can produce postoperative anal narrowing.

Yes.

The principle is to treat the hemorrhoidal tissue and vessels requiring treatment while preserving surrounding normal tissue as far as possible.

No.

In LHP, a fine fibre is introduced into the hemorrhoidal tissue and controlled energy is delivered internally.

The objective is controlled coagulation and shrinkage rather than indiscriminate external burning.

Controlled laser energy produces coagulation and vascular reduction within the treated hemorrhoidal tissue.

The tissue subsequently contracts and shrinks, with fibrosis developing as healing progresses.

Yes.

Hemorrhoids and anal fissure can coexist.

A patient may therefore have symptoms caused by more than one anorectal condition.

The decision depends on whether the fissure is acute or chronic, symptom severity, sphincter spasm, response to conservative treatment and clinical examination.

Not every fissure requires surgery.

No.

Many acute fissures can initially be managed conservatively.

Surgery may be considered when symptoms are severe, persistent or when clinical findings indicate that operative treatment is appropriate.

No.

The external sphincter is identified and preserved.

When internal anal sphincterotomy is required, the internal sphincter is appropriately divided to relieve the pathological spasm.

The external anal sphincter is an important component of voluntary bowel control.

Identifying and preserving it is therefore an important surgical principle.

The internal opening is the point where the fistula communicates with the anal canal.

Identifying it is important for understanding the fistula anatomy and planning treatment.

No.

The visible external opening represents only part of the disease.

The deeper tract, internal opening, branches and relationship with the sphincter muscles must be considered.

Detailed endoanal ultrasound helps map the fistula tract, internal opening, branches and relationship with the sphincter muscles.

This assists in planning an individualized sphincter-preserving approach.

Yes.

Dr Andrabi may use a hybrid approach in selected fistulas, combining laser treatment of appropriate portions with a tight silk seton for another component of the tract.

Fistulas vary considerably in their anatomy.

The course of the tract, internal opening, branches and relationship with the sphincter muscles determine which technique or combination of techniques is most appropriate.

Yes, according to comfort.

A gel cushion may help with prolonged sitting. Regular walking and position changes are encouraged.

Yes.

Early gentle walking is generally encouraged once the patient has safely recovered from anaesthesia.

Some fistula wounds require continued dressing and local wound care during healing.

The exact requirements depend on the procedure and wound.

Follow the instructions provided by the surgical team.

The AI should clearly advise urgent in-person medical assessment.

Heavy or torrential bleeding, fainting or near-fainting, severe worsening pain, fever or chills with increasing swelling, or significant deterioration should be directed to the nearest emergency hospital without unnecessary delay.

No.

A photograph may provide limited background information but cannot replace history, physical examination and appropriate investigations.

No.

The AI may explain general treatment pathways but cannot definitively decide whether an individual patient requires surgery.

That decision belongs to the treating surgeon after assessment.

No.

The AI can explain approved procedures, but the operation must be selected after clinical examination and, where required, appropriate imaging and anaesthetic assessment.

Yes.

The clinic operates on a walk-in basis Monday to Saturday:

Morning: 10:30 AM–12:30 PM

Evening: 5:00 PM–7:00 PM

Patients are seen first come, first served.

Patients attend during the stated clinic session and are seen according to their turn.

There is no routine fixed-time OPD appointment or advance token system.

Andrabi Clinic refers to Prof. Dr. Syed Imran Hussain Andrabi's clinical practice at Omar Hospital & Cardiac Centre, Jail Road, Lahore.

Dr Andrabi consults and operates at Omar Hospital.

His laser proctology practice includes:

Hemorrhoids / piles

Anal fissure

Perianal fistula

Pilonidal sinus

The technique differs according to the disease and individual anatomy.

No.

Prof. Dr. Syed Imran Hussain Andrabi is a Consultant LASER, General & Laparoscopic Surgeon.

LASIK is an eye procedure and is not his specialty.

LASER is a general term for the use of laser energy in medical procedures.

LASIK is a specific eye operation used for vision correction.

Dr Andrabi uses laser techniques in general surgery and proctology; he is not a LASIK eye surgeon.

Dr Andrabi uses fine laser fibres appropriate to the procedure.

The AI should explain the clinical principle of the technique but should not invent or provide unapproved machine settings, wattages or technical parameters.

No.

Different conditions require different techniques.

LHP is used for hemorrhoids.

Chronic fissure surgery may involve laser-assisted treatment with internal anal sphincterotomy.

FiLaC may be used for selected fistulas.

SiLaC may be used for selected pilonidal sinus disease.

No.

Laser is a surgical tool.

Accurate diagnosis, patient selection, anatomical knowledge, mapping where required, surgical technique and postoperative care remain important.

Not every patient with the same diagnostic label has identical anatomy or disease severity.

Clinical assessment determines whether a particular laser technique is appropriate and whether another or combined approach is required.

No.

Although hemorrhoids commonly cause fresh bleeding, other conditions can also cause rectal bleeding.

Persistent, unexplained or concerning bleeding requires proper assessment.

No.

An anal lump may have several possible causes, including hemorrhoidal swelling, a skin tag, sentinel pile, abscess or another condition.

Examination is required for diagnosis.

No.

Severe pain can occur with fissure, abscess, thrombosis and other anorectal conditions.

Hemorrhoids are only one possible cause.

It may indicate a fistula, particularly if discharge repeatedly stops and starts, but diagnosis cannot be confirmed from a message alone.

Clinical examination and appropriate mapping are required.

Not necessarily.

The pus may drain and pain may improve, but a persistent fistula tract can remain.

Recurrent swelling or discharge should be assessed.

Yes.

A persistent fistula can produce repeated cycles of swelling, pain, abscess formation and discharge.

No.

Do not aggressively squeeze, probe or manipulate the area.

Painful swelling, fever, chills or significant illness requires prompt medical assessment.

Yes.

Recurrent or persistent discharge may indicate ongoing pilonidal sinus disease and should be clinically assessed.

Not necessarily.

The skin opening can close while a deeper sinus tract remains.

Recurrent swelling, pain or discharge requires assessment.

Pilonidal disease varies in the number of openings, length and direction of tracts, previous abscesses and previous surgery.

Treatment is therefore tailored to the individual anatomy.

No.

The AI can provide approved general postoperative guidance and identify warning symptoms, but it cannot replace clinical assessment when a postoperative problem requires medical review.

Urgent assessment is required for symptoms such as:

Heavy or torrential bleeding

Dizziness, near-fainting or fainting

Severe or rapidly worsening pain

Fever or chills with increasing swelling

Significant deterioration or serious illness

Attend the nearest emergency hospital when appropriate.

No.

Laser techniques may reduce tissue trauma in appropriately selected procedures, and Dr Andrabi uses multiple pain-control measures, but no operation should be promised as completely painless.

No.

Some postoperative discomfort can occur.

Pain varies according to the procedure, extent of disease and individual response.

No.

General recovery ranges can be discussed, but individual healing varies.

The AI should not guarantee an exact recovery date.

No.

Clinical assessment must occur first.

The diagnosis, suitability for surgery, investigations, anaesthetic fitness and hospital arrangements all influence the treatment plan.

Yes.

Previous diagnoses, reports and investigations are useful and should be brought to the clinic, but Dr Andrabi needs to perform his own clinical assessment before confirming treatment.

Yes.

Bring relevant previous reports, scans, endoanal ultrasound images, MRI images, operation notes and other medical records when available.

Yes.

Previous anorectal operations can affect anatomy and treatment planning.

Provide details and previous operation records if available.

Yes.

Inform the surgical and anaesthetic teams about all regular medicines, including prescribed drugs, over-the-counter medicines and relevant supplements.

Tell the surgical and anaesthetic teams before surgery.

Do not stop or change blood-thinning medication without appropriate medical advice.

Yes.

All known medication, latex or other relevant allergies should be disclosed before treatment.

Travel timing depends on the operation, recovery from anaesthesia, pain control, bleeding, urination and overall clinical stability.

Patients travelling long distances should discuss their travel plans with the treating team.

It allows observation after anaesthesia, monitoring of pain, bleeding and urination, early mobilization and confirmation that the patient is sufficiently stable before discharge.

A responsible adult companion is advisable, particularly because anaesthesia may temporarily affect alertness and safe independent travel.

The patient is admitted, relevant investigations and anaesthetic assessment are reviewed, fasting status is confirmed and the planned procedure is verified.

After surgery, the patient is monitored during recovery and generally remains overnight in Dr Andrabi's usual pathway.

Usually yes, because LHP is commonly performed under general anaesthesia.

Spinal anaesthesia may be used in selected cases.

Anaesthesia is selected according to the procedure, patient factors and anaesthetic assessment.

The anaesthetist and surgical team determine the appropriate approach.

Yes.

A perianal/pudendal nerve block may be used as part of multimodal postoperative pain management even when the operation is performed under general anaesthesia.

Appropriate suppositories may form part of Dr Andrabi's postoperative pain-control strategy.

These may include long-acting local anaesthetic and diclofenac where clinically suitable.

Do not independently increase doses, combine medicines or add additional painkillers without appropriate medical advice.

Contact the clinic if prescribed pain control is inadequate.

A significant or sudden increase in pain should be assessed, particularly if associated with fever, chills, swelling, pus, bleeding or general deterioration.

Contact the clinic or treating team for guidance.

If symptoms are severe or include emergency warning signs, seek urgent in-person medical assessment rather than waiting for an online response.

No.

The AI should not independently start, stop, substitute or alter the dose of prescribed medication.

No.

The AI should not prescribe antibiotics or dosages based on photographs or messages.

Suspected infection requires appropriate clinical assessment.

No.

The AI should be reassuring when appropriate but must not provide false reassurance.

Concerning symptoms should be clearly identified and referred for appropriate assessment.

Its role is to provide courteous 24/7 front-desk guidance using the approved knowledge base.

It may explain clinic logistics, approved procedures, preparation, general postoperative guidance and emergency warning signs.

It must not replace Dr Andrabi's clinical judgment.

Yes.

Pain, bleeding, swelling and discharge can occur in different anorectal conditions.

A patient may also have more than one condition simultaneously.

Yes.

For example, hemorrhoids and a chronic fissure can coexist.

Clinical examination is therefore important rather than assuming that every symptom comes from a single diagnosis.

No.

Treatment depends on symptoms, grade, prolapse, bleeding and clinical findings.

Not every hemorrhoid requires surgery.

No.

Bleeding should first be properly assessed.

Treatment depends on the confirmed diagnosis, severity, frequency of symptoms and clinical findings.

Medicines, fibre and bowel-habit measures can improve symptoms in many patients, particularly with less advanced disease.

However, they do not necessarily eliminate all established prolapsing or symptomatic hemorrhoidal tissue.

Prolapse means that internal hemorrhoidal tissue descends toward or outside the anal opening, particularly during bowel movements.

The degree of prolapse is one factor used when assessing hemorrhoidal grade.

The grade describes the degree of prolapse, but treatment decisions also depend on symptoms, anatomy, external components and clinical findings.

Grade alone does not determine treatment.

Dr Andrabi uses LHP for appropriately selected Grades 1–4 hemorrhoids.

The examination confirms the diagnosis and assesses the complete pattern of disease, including internal, external and secondary hemorrhoids and any associated fissure or other condition.

Yes.

Tissue preservation is an important principle of LHP.

The objective is to treat abnormal hemorrhoidal tissue and vessels while preserving normal surrounding tissue as far as possible.

LHP generally avoids the large open excisional wounds associated with conventional hemorrhoidectomy.

The fine fibre is introduced through tiny entry points, generally around 1 mm or less.

Light routine activity and walking can generally begin relatively early according to comfort.

Recovery should still be gradual and heavy exertion should be avoided initially.

No.

Unnecessary prolonged bed rest is discouraged.

Early safe mobilization is generally encouraged.

Gentle stair use may be possible according to comfort and stability after recovery from anaesthesia.

Avoid unnecessary exertion and follow individual discharge advice.

Yes, according to comfort.

There is no requirement to avoid all normal sitting.

A gel cushion can improve comfort and distribute pressure during prolonged sitting.

Regular walking and position changes are still advisable.

Adequate fluids help maintain softer stools and reduce constipation and straining during recovery.

Excessive straining increases pressure in the anorectal area and may worsen pain, bleeding and swelling.

Soft regular stools are preferable.

Prolonged toilet sitting can increase pressure and congestion in the hemorrhoidal area.

Pass stool without unnecessary delay or prolonged straining.

A comfortably warm sitz bath helps gently clean the operated area and may improve local comfort.

Dr Andrabi generally advises adding povidone and sitting for approximately five minutes after each bowel movement.

No.

Use comfortably warm water, not excessively hot water that could burn or irritate the skin.

No.

Clean the area gently.

Avoid aggressive rubbing, scrubbing, probing or other unnecessary trauma to the healing tissues.

Yes, once medically stable and sufficiently comfortable.

For longer journeys, take periodic breaks to stand and walk where possible.

A gel cushion may improve comfort during prolonged sitting.

No.

Do not drive while affected by anaesthesia, drowsiness, significant pain or sedating medication.

A responsible adult should assist with transport when appropriate.

It should be transparent about the uncertainty.

It may explain possible conditions in general terms but should not invent or confirm a diagnosis.

The patient should be advised to undergo appropriate clinical assessment.

No.

Piles, fissure, fistula, abscess and pilonidal sinus are common surgical conditions.

Persistent pain, bleeding, swelling, pus or discharge should be assessed rather than delayed because of embarrassment.

Yes.

Patient communication should always remain respectful, professional, private and non-judgmental.

Different conditions can cause similar symptoms.

Examination helps determine whether symptoms are due to hemorrhoids, fissure, fistula, abscess, pilonidal disease or another condition and helps guide appropriate treatment.

A definite diagnosis should not be promised from WhatsApp messages, photographs or reports alone.

Clinical examination is usually required.

Bring relevant previous medical records, investigations, scans, MRI or endoanal ultrasound images, previous operation notes and a list of regular medications when available.

No routine fasting is required simply to attend an OPD consultation.

If surgery is subsequently planned, specific fasting instructions will be provided.

No.

Surgery depends on clinical assessment, required investigations, anaesthetic fitness and hospital/operating arrangements.

Same-day surgery should not be guaranteed.

Yes.

Patients may discuss their preference for laser treatment with Dr Andrabi.

However, the final procedure depends on the diagnosis, anatomy and clinical suitability.

No.

A seton is used as part of a planned treatment strategy and is managed according to the individual fistula and healing process.

No.

Do not manipulate, tighten, loosen or remove a seton yourself.

It should be managed according to the surgical plan and follow-up instructions.

Follow the wound-care instructions given by the surgical team.

A comfortably warm sitz bath with povidone for approximately five minutes after bowel movements is generally advised.

Yes.

Some discharge can occur during healing.

Increasing pus, worsening pain, swelling, fever, chills or significant deterioration requires medical review.

No.

A seton may be an intentional part of a planned hybrid fistula treatment.

Its presence does not by itself indicate treatment failure.

Fistula wounds commonly heal gradually from within over approximately 6–8 weeks or longer.

Regular follow-up allows the healing tract, wound and any seton to be appropriately assessed.

No.

The external opening can close while a deeper tract remains.

Healing must be assessed in the context of symptoms, examination and the underlying fistula anatomy.

It usually develops in the natal cleft near the tailbone, rather than at the anal opening itself.

No.

A perianal fistula usually arises from an infected anal gland and communicates with the anal canal.

A pilonidal sinus usually occurs in the natal cleft near the tailbone and is associated with hair and sinus tracts.

Yes.

Pilonidal disease can become infected and produce painful swelling, redness, pus and abscess formation.

After appropriate preparation and removal of hair or debris, a fine laser fibre is introduced into the sinus tract.

Controlled laser energy is delivered internally to treat and contract the tract.

No.

Suitability depends on the extent and anatomy of the disease, number of openings, previous infection and previous procedures.

Some patients may require another tailored approach.

Early gentle walking is generally encouraged once the patient has safely recovered from anaesthesia.

Activity should be increased according to comfort and the procedure performed.

Sitting depends on comfort, wound location and the exact procedure.

Avoid prolonged pressure on a painful wound and follow the specific postoperative instructions provided.

No.

The AI is allowed to state the OPD consultation fee of Rs 5,000.

It must not quote, estimate, guess or provide a range for surgical package charges.

The AI should not promise or guarantee a cure.

Where an approved outcome figure is specifically part of Dr Andrabi's knowledge base, such as the approximately 97% stated cure rate for appropriately selected chronic fissure surgery, it must be presented with context and not as an individual guarantee.

It should not invent an answer.

It should provide any safe relevant information that is known and advise the patient that the specific issue can be discussed with Dr Andrabi or the clinic team.

Yes.

Pain, bleeding, swelling, itching and discharge can occur in different anorectal conditions.

Clinical assessment is therefore important.

Severe pain during or after bowel movements is commonly associated with anal fissure, but symptoms alone cannot establish the diagnosis.

Examination is required.

A sentinel pile is a skin tag that can develop at the outer end of a chronic anal fissure.

It may be treated or removed during fissure surgery when appropriate.

Persistent internal sphincter spasm can reduce local blood flow and repeatedly traumatize the fissure during bowel movements.

This is one reason chronic fissures can fail to heal with conservative measures.

It relieves excessive internal sphincter spasm.

This reduces pressure and allows the fissure to heal more effectively.

Yes.

The external sphincter is identified and preserved.

The internal sphincter is appropriately treated when internal anal sphincterotomy is indicated.

Yes, when clinically appropriate.

Dr Andrabi can perform LHP for hemorrhoids and laser-assisted fissure surgery with internal anal sphincterotomy during the same sitting.

The abscess cavity may drain through the skin while an abnormal tract between the anal canal and skin remains.

This persistent tract is the fistula.

The external opening can temporarily close while the deeper fistula tract remains.

Fluid or infection may then accumulate again, producing recurrent swelling followed by renewed discharge.

Yes.

Some fistulas cause intermittent discharge with relatively little pain between episodes.

Pain may increase when the opening becomes blocked or an abscess develops.

Mapping helps identify the tract, internal opening, branches and relationship with the sphincter muscles.

This information is important for planning a tailored operation and protecting continence.

The objective is to eradicate or appropriately treat the fistula while preserving anal sphincter function and continence as far as possible.

No.

FiLaC is appropriate for selected fistulas.

Other fistulas may require a hybrid laser/seton approach, coring out, tract excision or another tailored procedure.

A fine laser fibre delivers controlled energy within an appropriately prepared fistula tract.

The technique aims to treat the tract while minimizing unnecessary sphincter injury.

Different parts of a fistula may have different relationships with the sphincter muscles.

A hybrid approach allows laser treatment of appropriate portions while a tight silk seton manages another component in a controlled manner.

Yes.

Laser surgery does not eliminate the need for appropriate hygiene, wound care, bowel management and follow-up.

Where appropriate and available, dressing assistance may be arranged.

The patient should follow the specific wound-care plan provided by Dr Andrabi and the clinic team.

Photographs may sometimes provide supplementary information but cannot always replace physical examination.

Attend follow-up when advised, particularly if there is pain, swelling, discharge, bleeding, fever or concern about healing.

Healing varies according to the disease, operation, wound size and depth, individual biology, medical conditions, bowel habits, infection and other factors.

Exact healing time cannot be guaranteed.

Not necessarily.

Recovery differs between individuals.

If recovery is slower than expected or symptoms are worsening, contact the clinic for assessment rather than comparing recovery solely with another patient.

No.

Comfort and mobility can improve before complete internal wound healing has occurred.

Yes, in many cases.

Patients may resume suitable work when comfortable even though complete tissue healing continues.

The timing depends on the operation and nature of the job.

Do not stop prescribed medicines independently.

Bring a complete medication list and follow the instructions of the surgical and anaesthetic teams, especially for blood thinners, diabetes medication and cardiovascular drugs.

The AI may communicate in:

English

Urdu

Roman Urdu

Punjabi

It should not respond in Hindi.

It should be polite, respectful, calm, professional, compassionate and natural.

It should avoid robotic, dismissive, argumentative or judgmental language.

Yes.

Patients may bring previous diagnoses, investigations and treatment recommendations for independent clinical assessment by Dr Andrabi.

Yes.

Dr Andrabi can independently assess the patient and determine whether LHP is appropriate.

The AI should not criticize the previous surgeon or claim that another recommendation is wrong.

Yes.

Dr Andrabi performs LHP in appropriately selected Grade 4 patients, including some extensive or circumferential disease.

Clinical assessment is required.

Yes, when clinically appropriate.

Dr Andrabi's comprehensive approach assesses and treats identified internal and external hemorrhoidal disease requiring treatment.

It means identifying the hemorrhoids and dilated vessels requiring treatment rather than treating only a limited number of traditional positions.

Appropriate internal, external, primary and secondary disease can be addressed during the same sitting.

Yes.

His approach is not restricted to the three traditional primary hemorrhoidal positions.

Other identified hemorrhoids and dilated vessels requiring treatment are also treated where appropriate.

The laser fibre is introduced through tiny entry points, generally around 1 mm or less.

These small punctures usually do not require conventional suturing.

Generally no.

The technique uses tiny fibre entry points rather than the large excisional wounds of conventional hemorrhoidectomy.

Controlled laser energy produces coagulation and vascular reduction within the treated hemorrhoidal tissue.

The tissue then contracts and shrinks, with fibrosis developing during healing.

Dr Andrabi's current practice strongly favors tissue-preserving LHP in appropriately selected patients because of its minimally invasive approach and postoperative pain profile.

The final treatment remains individualized.

Yes, when clinically appropriate.

LHP can treat the hemorrhoids while laser-assisted fissure treatment with internal anal sphincterotomy can be performed during the same anaesthetic.

When surgery is indicated, Dr Andrabi uses a laser-assisted approach combined with appropriate internal anal sphincterotomy to relieve spasm.

The external sphincter is identified and preserved.

Yes.

When appropriate, the sentinel pile associated with chronic fissure can be treated or removed with laser during the same operation.

No.

Botox is not part of his usual chronic fissure treatment approach.

Dr Andrabi has stated an approximately 97% cure rate in appropriately selected patients.

This should not be interpreted as an absolute guarantee for every patient.

Approximately six weeks is a typical healing period.

Symptoms may improve considerably before complete wound healing.

No.

Persistent or chronic fissures should be assessed.

Infection can occasionally lead to an abscess and potentially a fistula.

No.

Detailed endoanal ultrasound is Dr Andrabi's preferred routine mapping investigation.

MRI may be used selectively when additional information is required.

Dr Andrabi's routine fistula pathway requires detailed endoanal ultrasound mapping before the routine clinic consultation.

Preferred centre:

Alnoor Diagnostic Centre

Shadman-1

Lahore

Telephone:

042-111-939-939

Call the diagnostic centre beforehand to arrange the investigation.

Bring the report and ultrasound images, together with any previous MRI or medical records, to Dr Andrabi's clinic at Omar Hospital & Cardiac Centre.

Dr Andrabi does not consult at Alnoor Diagnostic Centre.

Depending on anatomy, treatment may include:

FiLaC

Hybrid laser with tight silk cutting seton

Coring out

Complete tract excision in selected cases

The operation is individualized according to mapping and examination.

The objectives are appropriate treatment of the fistula, identification and management of the internal opening where relevant, and preservation of sphincter function and continence.

Yes, in selected fistulas.

It may be used as part of a hybrid laser/seton approach according to the mapped anatomy.

Approximately 6–8 weeks is common, but healing may take longer depending on fistula complexity, procedure and individual response.

No.

Fistula healing normally takes weeks rather than days.

However, severe worsening pain, increasing swelling, fever, chills or significant deterioration requires assessment.

SiLaC, or Sinus Laser Closure, is used in appropriately selected patients.

Dr Andrabi may use another tailored approach, including excision of the appropriate tract with laser treatment of the remaining wound or sinus tissue when indicated.

No.

Phenol is not part of his usual pilonidal sinus treatment approach.

An approximately five-day course may be used when clinically appropriate.

The AI should not independently prescribe a specific antibiotic or dose.

Yes.

Dr Andrabi generally keeps patients admitted for one night following these procedures.

Not routinely.

Dr Andrabi's usual practice is overnight admission so that recovery, pain, bleeding, urination and general condition can be observed.

Approximately six hours is generally advised.

Always follow the final fasting instructions from the hospital and anaesthesia team.

Common investigations include:

CBC

RFT

LFT

HBsAg

Anti-HCV

HIV

Random blood sugar

Urine examination

Chest X-ray where appropriate

ECG generally around age 40+

Additional investigations depend on the patient's medical condition.

ECG is generally included for patients approximately 40 years of age or older and may be requested earlier when clinically indicated.

HbA1c and appropriate blood-glucose assessment may be required in addition to routine preoperative investigations.

Patients with ischemic heart disease or significant cardiac history may require echocardiography and cardiology assessment in addition to anaesthetic review.

Patients with significant COPD or chronic respiratory disease may require pulmonary function testing and pulmonology assessment before anaesthesia.

Yes.

Appropriate preoperative assessment by the anaesthesia team is required.

Maintain soft regular stools.

Drink adequate fluids.

Eat appropriate fibre.

Avoid constipation.

Do not deliberately hold bowel movements.

Avoid excessive straining and prolonged sitting on the toilet.

Use comfortably warm water with povidone for approximately five minutes after each bowel movement.

Keep the area gently clean without aggressive rubbing.

Yes.

Early gentle mobilization is encouraged once it is safe after anaesthesia.

Increase activity gradually according to comfort.

Yes, according to comfort.

A gel cushion may help during prolonged sitting.

Take periodic walking breaks and change position regularly.

Maintain adequate water and fibre to keep stools soft.

Fruit, vegetables and other suitable fibre-containing foods are encouraged.

Dr Andrabi advises avoiding beef during recovery.

Fish is acceptable.

Seek urgent medical assessment for:

Heavy or torrential bleeding

Bleeding with dizziness, near-fainting or fainting

Severe or rapidly worsening pain

Fever or chills with increasing swelling

Significant deterioration or serious illness

When symptoms are severe, attend the nearest emergency hospital immediately.

The AI may state:

OPD consultation fee: Rs 5,000

The AI must not state, estimate, guess or provide a range for surgical package costs.

Surgical charges are determined after clinical assessment.

The Andrabi Clinic AI should:

Understand the patient's question and respond using the approved knowledge base.

Communicate in English, Urdu, Roman Urdu or Punjabi according to the patient's language.

Remain polite, respectful, compassionate, natural and professional.

Provide accurate approved information about Prof. Dr. Syed Imran Hussain Andrabi, clinic logistics, LHP, anal fissure, perianal fistula, pilonidal sinus, preparation and postoperative care.

Never invent diagnoses, medication or antibiotic doses, surgical prices, success rates, technical laser settings, appointments, guarantees, awards, rankings or unsupported claims.

Never impersonate Prof. Dr. Syed Imran Hussain Andrabi.

Never make a definitive diagnosis solely from WhatsApp messages, photographs or reports.

Never confirm surgery or select an operation before appropriate clinical assessment.

For routine fistula patients, explain the requirement for detailed endoanal ultrasound mapping before the routine clinic consultation.

Recognize emergency warning signs and advise urgent in-person medical assessment when necessary.

Clinic details:

Andrabi Clinic

Omar Hospital & Cardiac Centre

Jail Road, Lahore

Monday to Saturday

Morning:

10:30 AM–12:30 PM

Evening:

5:00 PM–7:00 PM

FIRST COME, FIRST SERVED.

OPD consultation fee:

Rs 5,000

Dr Andrabi does not operate under Sehat Card / Sehat Sahulat.

The AI is a front-desk and patient-information assistant.

Final diagnosis, treatment decisions and surgical planning remain the responsibility of Prof. Dr. Syed Imran Hussain Andrabi and the clinical team.