Radiofrequency ablation for the treatment of haemorrhoidal disease: a minimally invasive and effective treatment modality

Abstract

Background: Haemorrhoidal disease (HD) is a common colorectal condition that often requires surgical treatment. Less invasive procedures are usually more acceptable to patients. The aim of this study was to report the outcome of a novel and minimally invasive technique employing a radiofrequency ablation (RFA) energy (Rafaelo®) to treat HD.

Methods: A total number of 27 patients who had RFA for the treatment of HD were recruited to this study. The procedure was performed under deep sedation and local anaesthesia. Patients' demographics; haemorrhoid severity score (HSS); quality of life; pain and satisfaction scores; and recurrence rate were recorded.

Results: The mean age of the patients was 46 (SD 14) years, 18 (67%) males and 9 (33%) females. The mean body mass index was 25 (SD 4) kg/m2. The predominant symptom of all patients was per-rectal bleeding. HSS improved from 7.2 (SD 1.9) before the procedure to 1.6 (SD 1) after the procedure (p < 0.0001). Postoperative pain scores on a scale of 0-10 were 0, 2 (SD 2), 1 (SD 2), and 0 on immediate, day-1, day-3, and 2-month follow-up questionnaire. The mean satisfacion score was 9 (SD 1.5) out of 10 on 2-month follow-up. Mean time until patients returned to normal daily activity was 3 (SD 1) days following the procedure. Quality-of-life assessments including: visual analogue scale scores (before: mean 70, SD 23; after: mean 82, SD 16; p < 0.001) and EQ-5D-5L (before: mean 0.84, SD 0.15; after: mean 0.94, SD 0.13; p < 0.05) were significantly improved. The mean length of follow-up for recurrence of symptoms was 20 months (range 12-32 months). One patient (4%) reported the recurrence of rectal bleeding 12 months after the procedure.

Conclusions: RFA for the treatment of HD is safe and effective in achieving symptomatic relief. It is associated with minimal postoperative pain and low incidence of recurrence.

Keywords: Hemorrhoids; Minimally invasive surgical procedures; Patient reported outcome; Radiofrequency ablation.

Conflict of interest statement

Modern Aesthetic Solutions Ltd (Registered Office: 39 Steeple Close, Poole, Dorset BH17 9B) has provided the Rafaelo® radio frequency device as a loan for 5 years to the University College London Hospital and funded the cost of Rafaelo® specific equipment for the initial 10 patients who underwent radiofrequency ablation of haemorrhoids. Furthermore, Modern Aesthetic Solution Ltd continues to sponsor a biannual live link course at University College London Hospital to teach radiofrequency ablation for haemorrhoids to other surgeons.

Figures

Fig. 1

HPR45i probe (a) is inserted into the haemorrhoidal tissue (b), tissue is tilted away from the submucosa (c), and the radiofrequency energy is applied until the tissue exhibits whitish discoloration (d, e)

Fig. 2

Haemorrhoidal disease severity and quality of life was assessed 2–3 weeks before and 6–8 weeks after the procedure. Haemorrhoidal Severity Score (A); Visual Analogue Score on a scale of 0–100 quality of life in relation to haemorrhoidal disease (B); and EQ-5D-5L crosswalk index values (C) were significantly improved comparison before and after the procedure. p < 0.05 (*). p < 0.01 (**). p < 0.0001 (****)