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| Name | SURGERY OF HYPERTROPHIED PAPILLAE AND HEMORRHOIDS |
| Video Uploader | Video From Dr Pravin J Gupta, MBBS MS Laxmi Nagar, NAGPUR, IN |
| Upload Date | This Video Uploaded At 19-01-2025 03:57:53 |
| Video Discription | DISCLAIMER- Medical Educational Video. Not to promote sexuality or Nudity. Hypertrophied anal papillae and fibrous anal polyps, should they be removed during HEMORRHOIID surgery? Hypertrophied anal papillae are essentially skin tags that project up from the dentate line, or the junction between the skin and the epithelial lining of the anus. They are often found as part of the classic triad of a chronic fissure, namely the fissure itself, hypertrophied papilla above and a skin tag below. They are also found in isolation, maybe firm and palpable on a digital examination of the anus. In this situation, they must be differentiated from polyps, hemorrhoids, or other growths. Endoscopically they could be differentiated from an adenomatous polyp by their white appearance and their origin from the lower (squamous) aspect of the dentate line in the anal canal. They are usually a symptomatic but occasionally grow large enough to be felt by the patient or are likely to prolapse. Hypertrophied anal papilla should be included in the differential diagnosis of a smooth mass located near the anal verge, especially in a patient with a history of chronic anal irritation or infection. With passage of time, papillae continue to grow in size. A papilla is liable to acquire considerable fibrous thickening over a period of time when it gets a rounded expanded tip, which is known as a fibrous polyp. This is due to piling up and consolidation of chronic inflammatory tissues at the proximal part of the fissure at the dentate line. As many as 16% of the patients having chronic fissure in anus recorded the presence of papillae that turned into fibrous polyps. These papillae are presumed to be caused by edema and low-grade infection. A fibrosed-hypertrophied papilla is also frequently found at the upper part of a chronic anal fissure or guarding the internal opening of fistula in anus. In the later case however, the symptoms may completely dominate and distort the clinical findings. Dilated veins, white areas, and a large hypertrophied anal papilla are often found in prolapsing types of hemorrhoids. In the past, these structures were not given any importance and were left untreated. Those patients, in whom, the fissure in anus was treated but the concomitant papillae or polyps were left untouched, continued to complain of pruritus, wetness, or an intermittent pricking sensation in the anus. Those with fibrous polyps felt incompletely treated due to a feeling of something projecting from the anus. Even a case of giant hypertrophied anal papilla complicated with a massive anal bleeding and prolapse was reported. Anal papillae were found in almost 50%-60% patients examined by us in regular practice. Usually, they were small, caused no symptoms, and could be regarded as normal structures. However, if it is a case of hypertrophy and the papillae start projecting in the anal canal, it not only requires attention but calls for a suitable treatment also. In such cases, there are chances of increase in the mucus leak resulting in increased anal moisture. These are liable to get traumatized and inflamed during the passage of stool. In addition, on being converted into a fibrous polyp, they tend to project at the anal orifice during defecation, often requiring to be digitally replaced. These polyps are considered as one of the differential diagnoses of rectal prolapse. The patients also reported symptoms like pruritus, a foreign body sensation, pricking, a nagging sense of incomplete evacuation and heaviness in the anal region. As a routine practice, these pathologies were not given any importance. There is very brief reference to this entity in the standard textbooks and other references. Secondary goals of fissure surgery sometimes required the removal of hypertrophied papilla and skin tag as well as the removal of inflammatory and fibrotic tissues surrounding the fissure. Customarily, in the symptomatic papillae or polyps, their removal by crushing of the bases, excision after ligation or electrocautrization has been suggested. All these procedures are time consuming and are associated with complications at times. The use of radio frequency devices to deal with these pathologies has been found to be a quick, easy and significant complication free procedure. The device can ablate the papillae instantly, while the fibrous polyps can be excised after coagulation of the bases and thereafter the pedicles. |
| Category | Science & Technology |
| Tags | #sphincterolysis | # internal sphincter manipulation | # chronic anal fissures | # spastic internal sphincter fibers | # sphincterotomy | # minimally invasive for anal fissures | # anal fissure treatment | # anal fissure and sentinel pile | # anal dilatation | # anal incontinence | # quick treatment for anal fissure | # painless treatment for anal fissures | EXCISION OF SENTINEL PILE WITH LASER | LASER ABLATION | LASER CURETTAGE | ANAL SPHINCTEROLYSIS | CHRONIC FISSURES #sphincterolysis |
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