Removal of hypertrophied anal papillae and fibrous anal polyps increases patient satisfaction after anal fissure surgery

Hypertrophied anal papillae and fibrous anal polyps are frequently found in association with chronic fissure in ano. Usually, no specific attention is given to them and they are considered normal findings. The present prospective study was aimed at determining whether removal of hypertrophied anal papillae and fibrous anal polyps while dealing with chronic fissure in ano confers long-term benefit to patients. Between July 1999 and December 2000, 140 patients undergoing anal sphincterotomy were randomized into two groups to have their fibrous polyps and hypertrophied anal papillae either removed by radiofrequency surgery or left intact. After two years, they underwent a detailed interview by an independent, masked investigator. Overall 84% of patients who had polyp and papilla removal rated the outcome of their surgery as excellent or good in comparison to 58% of controls. The mean satisfaction grading was 9.2 on a visual analogue scale in the treatment group compared to 8.1 in controls (p=0.004). Removal of hypertrophied anal papillae and fibrous anal polyps should be an essential part of treatment of chronic fissure in ano. Persistence of these structures leaves behind a sense of incomplete treatment, reducing the overall satisfaction on the part of the patient. Radiofrequency procedure is useful in eradication of these concomitant pathologies.