Radiofrequency thermocoagulation of haemorrhoidal bundles, an alternative technique for the management of internal haemorrhoids.

Purpose: To describe our experience of radiofrequency thermocoagulation (RFT), assessing patient symptoms and quality of life (QoL) before and after the intervention.

Methods: Between April 2016 and April 2018, 42 outpatients were operated for internal haemorrhoids using RFT. Haemorrhoids were externalised to the anal margin and treated by using the Rafaelo® procedure, using the HPR45i probe (F-Care-Systems) under general anaesthesia. Assessment was performed prior to the intervention and during follow-up for prolapse degree using the Goligher scale; bleeding, improvement, and satisfaction using a verbal analogical scale; and the burden of haemorrhoidal disease using the HEMO-FISS-QoL questionnaire.

Results: In September 2018, 39 patients (26 males, mean age 51 [22-77]) were interviewed after an RFT intervention, during which a mean of 4.296 J was applied per patient. After a mean follow-up of 15 months, bleeding drastically decreased from 7/10 to 1/10 (p < 0.0001) and entirely stopped in 62% of patients. Prolapse significantly reduced from grade 3 to 2 (p < 0.0001) and completely disappeared in 9 out of 33 patients. Only 49% required postoperative level 2 analgesics, and 7 external thromboses were the only complication reported. Average incapacity for work was 1.72 days. All patients reported improvement of haemorrhoidal disease with a satisfaction rate mean score + 4/5. Haemorrhoidal discomfort decreased from 7/10 to 2/10 (p < 0.0001). HEMO-FISS-QoL score significantly improved, dropping from 24.91 to 5.94 (p < 0.001). Among all patients, 85% would choose RFT again if necessary and 90% would recommend it.

Conclusion: RFT treatment reduced haemorrhoidal bleeding and prolapse, and improved patient QoL.