Removal of hypertrophied anal papillae and fibrous polyps improves outcome of anal fissure surgery

BACKGROUND: The presence of Hypertrophied anal papillae and fibrous anal polyps are often ignored in the proctology practice. But the experience is that they tend to produce minor but disturbing symptoms. This study is aimed to assay the impact and utility of attending to these two conditions concurrently while dealing with cases of fissure in ano. MATERIAL AND METHODS: A study was carried out in 136 patients of chronic anal fissure having concomitant hypertrophied anal papillae or fibrous anal polyp. After relieving sphincter spasm by sphincterotomy, the polyps or papillae were destroyed using the radio frequency device. A comparison was made for the associated complaints like pruritus, pricking sensation, wetness, crawling in the anus etc. before and after removal of the papillae or polyps by an independent observer blinded to the procedure. RESULTS: After one month of the procedure, the associated symptoms were reduced to a significant amount along with a near total decline in the primary complaints of pain and bleeding. There was significant reduction in pruritus (P=0.0003), discharge per anus (P=0.0006), crawling sensation in the anus (P=0.0004) and sense of incomplete evacuation (P=0.001) At the follow up after 18 months, only 9% patients had recurrence of either anal fissure or symptoms like pruritus. CONCLUSION: This study establishes that removal of hypertrophied anal papillae and fibrous polyps should be carried out as a routine during surgical treatment of anal fissure. This would add to effectiveness and completeness of the procedure.

Keywords
Hypertrophied anal papilla, Fibrous anal polyp, Radio frequency, Anal fissure, Sphincterotomy