Hypertrophied Anal Papillae and Fibrous Anal Polyps. Should They Be Removed?

Hypertrophied anal papillae and fibrous anal polyps are not given due importance in the proctology practice. They are mostly ignored being considered as normal structures.
The present study is aimed to establish that hypertrophied anal papillae and fibrous anal polyps can cause symptoms and could produce concern to the patients and that these should be removed while dealing with patients of chronic fissure in-ano.
Two groups of patients were studied. Hundred patients were studied in Group A where the associated fibrous polyps or papillae were removed by radio frequency surgical device after performing a lateral subcutaneous sphincterotomy for relieving the sphincter spasm. Another group of 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.
Eighty nine per cent of 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).
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.