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FAQs on Gallstones, Piles, Fissure, Fistula, Hernia & Obesity

Gallstones develop when bile becomes oversaturated and tiny crystals form. Over time, these micro-crystals combine and grow into larger stones.
  • Discomfort or pain in the upper abdomen (especially right side)
  • Bloating after meals
  • Nausea or vomiting
  • Jaundice (if a stone blocks the common bile duct)
    • An ultrasound of the whole abdomen is the investigation of choice.
  • If asymptomatic: Usually just observation
  • If symptomatic: Surgery (laparoscopic/keyhole surgery) is recommended
  • For high-risk patients (diabetic or immunocompromised): Surgery is usually advised even without symptoms
    • Untreated gallstones may lead to serious complications such as:
  • Recurrent infections (chronic or acute cholecystitis)
  • Gangrene or perforation of the gallbladder
  • Jaundice or pancreatitis
  • Rarely, gallbladder cancer
  • Special conditions like Mirizzi syndrome or gallbladder-colon fistula
    • Jaundice happens when a stone slips into the common bile duct (CBD), blocking the flow of bile into the intestine. In such cases, the CBD stone must first be removed, followed by laparoscopic gallbladder removal (cholecystectomy).
    Phimosis is the inability to pull back (retract) the foreskin covering the head of the penis.
    It may be present from birth or develop later due to:
  • Repeated infections
  • Poor hygiene
  • Diabetes
  • Weak immunity (immunocompromised patients)
    • The main treatment is surgery (circumcision), where the foreskin is removed. This can be done with stitches or with a stapler technique.
  • Faster recovery
  • Neater and smoother cut line
    • No, circumcision does not negatively affect sexual performance. In fact, it often improves comfort and makes intercourse easier by allowing painless foreskin retraction.
    It is a small cut or tear in the anal region, which causes sharp pain and discomfort while passing stools.
    Passing hard stools can tear the delicate lining (mucosa) of the anal canal. If this happens repeatedly, it may become a chronic fissure, leading to muscle spasm, which further worsens the pain and tear.
    No special tests are required. A clinical examination by a doctor is usually sufficient.
  • Medical treatment: Medicines to reduce spasm and pain, and stool softeners.
  • Surgical treatment: Removal of the fissure and release of muscle spasm (lateral sphincterotomy).
    • Yes, LASER treatment is a safe and effective option.
  • Relatively painless procedure
  • Faster healing
  • Early recovery and return to routine activities
    • If performed properly, fissures usually do not recur.
    Yes. Fissures associated with IBD can be more challenging to treat.
    Yes, fissures and piles can occur at the same time, and both can be treated together.
    Piles are enlarged blood vessels in the anal region that form soft cushions. When they become swollen or symptomatic, treatment may be needed.
    Hemorrhoids are classified into Grade I, II, III, and IV, depending on their severity.
  • Grade I & II: Often managed with medicines and lifestyle changes.
  • Grade III (with bleeding) & Grade IV: Usually require surgical treatment.
  • Conventional (open) surgery
  • Stapler surgery
  • LASER surgery
    • No. Treatment must be tailored according to the grade and patient’s condition.
    Recurrence can happen if contributing factors (like constipation and poor dietary habits) are not corrected.
    Yes. In carefully selected cases, LASER treatment provides excellent results with quicker recovery.
    Yes. Piles can coexist with other conditions such as fissures or fistulas, and may be treated together if needed.
    A fistula-in-ano is an abnormal tract (tunnel) that forms between the anal canal/bowel and the skin around the anal area.
    It usually develops after an infection or pus collection in the perianal region, which bursts and forms a persistent tract.
    No. It may temporarily appear to heal, but usually reopens and recurs.
    The treatment is surgical and may involve removing or laying open the fistula tract.
    Yes. In carefully selected cases, LASER treatment can provide good results.
    Yes. Recurrence is more common in complex or multiple-branch fistulas, though proper treatment reduces the risk.
    A hernia occurs when an organ or tissue pushes out through a weak spot in the surrounding muscles or cavity wall.
    Examples include intestines or omentum protruding through the abdominal wall, or the stomach slipping into the chest (hiatus hernia).
  • Visible swelling or bulge, which increases on coughing or straining
  • Swelling may reduce when lying down or by gentle pressure
  • Long-standing hernias may grow larger and become difficult to reduce
    • Hernias can occur at any age:
  • In young children, they are usually present from birth (congenital).
  • In adults, they may develop due to muscle weakness, after surgery, or with aging.
    • The only effective treatment is surgical repair.
    The hernia is repaired and a mesh is placed to strengthen the weak area and prevent recurrence.
    Yes, but recurrence is rare (1–2%) with proper repair. Large or previously recurrent hernias carry a higher risk.
    Yes. Laparoscopic hernia repair is done through small cuts on the abdomen.
    Yes. In expert hands, laparoscopic surgery is safe and gives excellent results with faster recovery.
    Obesity means having excess body weight. It is measured using the Body Mass Index (BMI), which is calculated as weight (kg) divided by height (m²). A BMI of 30 or more is classified as obesity.
    Yes. Obesity is considered a disease and is often called the “mother of other diseases,” as it increases the risk of diabetes, high blood pressure, knee and back problems, sleep apnea, and many other health issues.
  • First line: Diet control, lifestyle changes, and regular exercise.
  • If obesity is due to another medical condition, that should be treated.
  • If these measures fail, metabolic (bariatric) surgery may be recommended.
    • These are surgical procedures for uncontrolled obesity that help change metabolism, so the body uses excess fat as energy, leading to weight loss and improvement of obesity-related complications.
    Through laparoscopic (keyhole) surgery, the stomach and intestines are remodeled to reduce food intake and/or absorption (restriction or malabsorption techniques).
    Yes. In experienced hands, they are as safe as other common surgeries such as gallbladder removal or knee replacement.
    Most patients achieve significant weight loss within 6 to 8 months after surgery.
    Yes. Weight loss often leads to improvement or resolution of diabetes, high blood pressure, joint pains, back pain, and sleep apnea.
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