 Hypertrophied anal papillae and fibrous anal polyps: should they be removed during anal fissure surgery?

Abstract

Objective: The present study is aimed to establish that hypertrophied anal papillae and fibrous anal polyps can cause symptoms and could cause concern to the patients and that these should be removed while dealing with patients of chronic fissure in ano. Method: Two groups of patients were studied. One-hundred patients were studied in Group A where the associated fibrous polyp or papillae were removed by radio frequency surgical device after performing a lateral subcutaneous sphincterotomy for relieving the sphincter spasm. Another group of one-hundred patients who also had papillae or fibrous polyps, were treated by lateral sphincterotomy alone. They were followed up to one year to assess their complaints. Results: 89% patients from Group A expressed their satisfaction with the treatment in comparison to only 64% from Group B who underwent sphincterotomy alone with the papillae or anal polyps left untreated. Group A patients showed a marked reduction with regard to pain and irritation during defecation (p=0.0011), pricking or foreign body sensation in the anus (p=0.0006) and pruritus or wetness around the anal verge (p=0.0008). Conclusion: Hypertrophied anal papillae and fibrous anal polyps should be removed during treatment of chronic anal fissure. This would add to effectiveness and completeness of the procedure. Key words: Hypertrophied anal papillae, fibrous anal polyps, radio frequency surgery, fissure-in-ano, sphincterotomy