No surgery is usually necessary for anal fissures. These fissures usually result from chronic constipation, so the first step would be to make sure you are moving your bowels regularly without straining, therefore you need to be on a regular dose of laxatives (such as miralax) plus stool softeners (such as colace). These are over the counter. Lubowell may help but sometimes it is not enough. Sometimes a prescription cream needs to be added to help the healing of the fissure (such a nitroglycerin rectal cream), however you would need to be seen by a gastroenterologist or colorectal surgeon. I don t know what you mean by a tube like structure (maybe a skin tag, a polyp, a condyloma?), but you probably need to be evaluated by either of these doctors. hope that helps