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

Abstract

Objective: The present study is aimed to establish thathypertrophied anal papillae and fibrous anal polyps cancause symptoms and could cause concern to thepatients and that these should be removed whiledealing with patients of chronic fissure in ano.Method: Two groups of patients were studied. One-hundred patients were studied in Group A where theassociated fibrous polyp or papillae were removed byradio frequency surgical device after performing alateral subcutaneous sphincterotomy for relieving thesphincter spasm. Another group of one-hundredpatients who also had papillae or fibrous polyps, weretreated by lateral sphincterotomy alone. They werefollowed up to one year to assess their complaints.Results: 89% patients from Group A expressed theirsatisfaction with the treatment in comparison to only64% from Group B who underwent sphincterotomyalone with the papillae or anal polyps left untreated.Group A patients showed a marked reduction withregard to pain and irritation during defecation(p=0.0011), pricking or foreign body sensation in theanus (p=0.0006) and pruritus or wetness around theanal verge (p=0.0008).Conclusion: Hypertrophied anal papillae and fibrousanal polyps should be removed during treatment ofchronic anal fissure. This would add to effectivenessand completeness of the procedure.Key words: Hypertrophied anal papillae, fibrous analpolyps, radio frequency surgery, fissure-in-ano,sphincterotomy