P J Gupta1. 1. Gupta Nursing Home, Nagpur, India. drpjg_ngp@sancharnet.in
Abstract
BACKGROUND: The presence of Hypertrophied anal papillae and fibrous anal polyps are often ignored in 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 these two conditions concurrently while dealing with cases of fissure in ano. PATIENTS AND METHODS: The study was carried out in 136 patients with chronic anal fissure having concomitant hypertrophied anal papillae or fibrous anal polyps. 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 sensation in the anus etc. before and after the removal of 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 extent along with a nearly 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 that of incomplete evacuation (p=0.001) At the follow up after 18 months, only 9 % of 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 on a routine basis during surgical treatment of anal fissure. This would add to the effectiveness and completeness of the procedure.
BACKGROUND: The presence of Hypertrophied anal papillae and fibrous anal polyps are often ignored in 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 these two conditions concurrently while dealing with cases of fissure in ano. PATIENTS AND METHODS: The study was carried out in 136 patients with chronic anal fissure having concomitant hypertrophied anal papillae or fibrous anal polyps. 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 sensation in the anus etc. before and after the removal of 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 extent along with a nearly 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 that of incomplete evacuation (p=0.001) At the follow up after 18 months, only 9 % of 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 on a routine basis during surgical treatment of anal fissure. This would add to the effectiveness and completeness of the procedure.