Dedication, Clinical Audit and How to Use This Handbook

In Memoriam

🕊️ IN MEMORIAM

“On 22 December 2019, Mohammad Fahim Siddiqui finally laid down his scalpel.” — Nasima Siddiqui, his daughter

Dedicated to the memory of Dr. Mohammad Fahim Siddiqui (14 December 1941 – 22 December 2019), the Father of Anal Surgery in Eastern Saudi Arabia and Head of the Surgery Department at Mohammad Dossary Hospital for more than 40 years. Every patient we examine with gentleness and every sphincter we protect honours his legacy.

Why This Handbook Exists — The MDH Audit Reality

Between 2020 and 2025, our department at Mohammad Dossary Hospital audited 987 anorectal procedure records (845 LigaSure excisions [85.6%], 106 stapled procedures [10.7%], and 36 conventional or other procedures [3.6%], alongside 336 sphincter procedures, 167 fissurectomies, and 25 fistulectomies or fistulotomies). Across the Emergency Department, primary-care clinics, and inpatient wards, one lesson stood out:

• The “just haemorrhoids” reflex is the most dangerous reflex in anorectal care.

• Most avoidable anorectal harm — delayed cancer diagnosis, missed abscess, iatrogenic sphincter injury — happens before the patient reaches a surgeon.

• This handbook gives emergency physicians, family physicians, medical specialists, and nurses a fast, colour-coded, algorithmic system to get the diagnosis, the first treatment, and the escalation right the first time.

Spelling note: Version 2 uses UK/international spelling (haemorrhoid, oedema, anaesthesia, faecal, paediatric).