Evaluation of the efficacy and morbidity of radiofrequency thermocoagulation in the treatment of hemorrhoidal disease

What can patients expect in the long term from radiofrequency thermocoagulation of hemorrhoids on bleeding, prolapse, quality of life, and recurrence: “no pain, no gain” or “no pain but a gain”?

“…Radiofrequency hemorrhoidal treatment, excepting Ligasure (Medtronic, Dublin, Ireland) and harmonic scalpels that are nonconservative surgical techniques, has been poorly studied; therefore, this study started from limited data. At the end of the study in September 2021, the literature review of published studies using PubMed Central (keywords: "radiofrequency and hemorrhoids, " "RFITT, " "Rafaelo procedure, " "radiofrequency thermocoagulation" except Ligasure) showed publications from only 8 different centers (1 in India [26], Czech [27], Germany [28], and Russia [29] and 2 in the United Kingdom [30,31] and France [20,32]). There are no publications comparing RFT following Rafaelo procedure with other surgical techniques, but one with DGHAL and RFT combined [29].…”

“…The Rafaelo technique used in this study is radically different by introducing an electrode directly into the internal hemorrhoidal pack. Duben et al [34] described its pilot experience from 2007 to 2017 over 217 patients but with a 35% participation rate at 4 years [35], with other studies including only 74 patients with a 3-month follow-up [32], 70 patients at 6 months [28], 42 patients for 12 months [31], 27 patients for 20 months [30], or 73 patients for 24 months [36]. Thus, the strengths of the presented study are the description of the largest case series reported in France, one of the largest numbers of cases worldwide published and a high and sat- What can patients expect in the long term from radiofrequency thermocoagulation of hemorrhoids on bleeding, prolapse, quality of life, and recurrence: "no pain, no gain" or "no pain but a gain"?…”

“…In this study, the Rafaelo procedure was modified without the use of anoscopy in order to facilitate access to the hemorrhoidal packs with their exteriorization at the anal margin. This may explain the absence of anal fissure observed elsewhere among postoperative complications [32,34].…”

French multicentre prospective evaluation of radiofrequency ablation in the management of haemorrhoidal disease

“…The energy is converted into heat to destroy haemorrhoidal vessels and initiate a process of submucosal fibrosis. Although radiofrequency ablation (RFA) by the Rafaelo © procedure is already used in many European countries, there are only few studies on this minimally invasive technique [9][10][11][12][13][14]. Most of them are retrospective with low numbers of patients and conducted in one or two centres.…”

“…At 3 months, the rate of patients reporting bleeding (21% vs. 84%, p < 0.001), prolapse (34% vs. 91.3%, p < 0.001) and anal discomfort (0/10 vs. 5/10, p < 0.0001) decreased significantly. Median medical leave was 4 days [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. Postoperative pain was 4/10, 1/10, 0/10 and 0/10 at weeks 1, 2, 3 and 4.…”