Operation

• Grade I: Bleeding due to internal hemorrhoids. No external prolaps of the hemorrhoids.
• Grade II: Hemorrhoids slip out of the anal canal when squeezing but spontaneously re-enter the anal canal at the end of the exertion.
• Grade III: The hemorrhoids emerge out of the anal canal when squeezing and must be pushed back manually into the canal.

The aim of the  procedure is to reduce the volume of the hemorrhoids by destroying them with radiofrequency. The sphincter of the anus is protected with injection of a layer of water between the hemorrhoids and the anal sphincter.  Than a needle will puncture  the different hemorrhoids on at a time. Due to radiofrequency, the needle will develop a heat localy that coagulates and  destroys the small blood vessels. This procedure is repeated several times by puncturing the different hemorrhoids with the same needle.

After the treatment, the various coagulated hemorrhoids become necrotic, reduce in volume and develop local fibrosis, so that the hemorrhoids no longer bleed and have less tendency to slip out of the anal canal when squeezing.

The procedure is minimally invasive and less painful than a hemprrhoidectomy. It can be repeated if recurrence appear. The procedure can be combined with one or more hemorrhoidectomies.

A temporary mild bloody anal fluid loss may be present after the procedure, as well as moderate false stool distress (urge to defecate without the presence of stool in the rectum).

Bleeding (laser)

• 2% significant bleeding in the first 2 weeks
  
• It is normal to have a bloody discharge with stools in the first two weeks in +/- 20% of cases.
  

Pain symptoms

• Radiofrequency ablation of haemorrhoids is much less painful than resection of haemorrhoids or than haemorrhoidopexy according to Longo.
• In most patients, the pain will disappear after 10 days. In rare cases, an external haemorrhoid may develop.
• The majority of patients resume work after 5 – 7 days.

False chair urge

• Incidence 4 – 6%.
• Urge to defecate without the presence of stool in the rectum.
  

Urinary retention

• 1 – 4%.
• Especially in men with an enlarged prostate (prostatic hypertrophy).
  
• Sometimes temporary placement of a urinary catheter will be necessary.
  

Rare complications

• Rare development of abscess and anal fistula.

Recurrence symptomatic report (bleeding)

• 21.5% recurrence after 5 years.
  
• 5-10% require reoperation.
  

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”?Annals of Coloproctology 2022;Published online: October 11, 2022. Jean-Michel Didelot
Early and midterm results of radiofrequency ablation (Rafaelo® procedure) for third-degree haemorrhoids: a prospective, two-centre study. Tolksdorf S, Tübergen DTech Coloproctol. 2022 Jun;26(6):479-487. doi: 10.1007/s10151-022-02608-x. Epub 2022 Mar 19
Radiofrequency Ablation (Rafaelo Procedure) for the Treatment of Hemorrhoids: A Case Series in the United Kingdom.
Hassan S, McGrath D, Barnes R, Middleton S.
Ann Coloproctol. 2021 Aug 18. doi: 10.3393/ac.2021.00276.0039.
Radiofrequency ablation for the treatment of haemorrhoidal disease: a minimally invasive and effective treatment modality.Eddama MMR, Everson MTech Coloproctol. 2019 Aug;23(8):769-774. doi: 10.1007/s10151-019-02054-2. Epub 2019 Aug 9.

Normal symptoms

• Anal pain is normal but should subside over time.
• A burning sensation and a constant false urge to defecate during the first 2 weeks.
• Seepage of serous (yellowish) anal fluid.
• Fluid loss may be bloody but should subside over time.

Abnormal symptoms

Contact your surgeon or GP, or go to the emergency room:

• If pain increases over time.
• If fever does not subside over time.
• If pus volume increases or foul smelling viscous fluid increases.
• If blood loss persists.

If symptoms seem abnormal to you, contact your GP (general practician).

If this is not possible, contact your surgeon.

If you are unable to contact your GP (general practician) or surgeon, go  to the St Elisabeth hospital emergency department.

Change in sensation in the anal canal

After surgery, sensation during anal sexual intercourse may be altered.

Incontinence

No risk of incontinence.