Radio Frequency Removal of Hypertrophied Anal Papillae and Fibrous Anal Polyps

The presence of hypertrophied anal papillae and fibrous anal polyps is mostly ignored while dealing with chronic anal fissures. However, anal papilla tends to produce a discharge resulting in a sodden perianal skin with itching and discomfort. Similarly, polyps can prolapse, bleed or traumatize. 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. Method: A prospective study was carried out in 100 patients of chronic anal fissure with concomitant hypertrophied anal papillae or fibrous anal polyp. Radio frequency surgical technique was employed to destroy the papillae and polyps after a lateral sphincterotomy. Associated complaints like pruritus, pricking sensation, wetness, crawling in the anus etc. were subjected to comparison before and after removal of the papillae or polyps by an independent observer. Results: At a follow up of one month, anoscopy conducted on the patients showed total eradication of the treated papillae. The associated symptoms were reduced significantly and there was a marked decline in the primary complaints of pain and bleeding. At 24- month follow-up, 2% patients had recurrence of fissure, but none was found to have the papilla or polyp. Conclusion: Hypertrophied anal papillae and fibrous anal polyps encountered during surgical treatment of chronic fissure in ano should be removed to improve patient compliance. Radiofrequency procedure can tackle these associated pathologies effectively.