Rafaelo™ Procedure – radiofrequency ablation for the treatment of haemorrhoids

Radiofrequency ablation is a treatment that uses heat from a small medical probe. This heat is created using radiofrequency, which is the same type of energy that heats up food in a standard kitchen microwave oven. The same method is commonly and successfully used to treat varicose veins. For haemorrhoids, the heat helps them shrink significantly, thereby reducing the symptoms they cause.” In many cases, the internal haemorrhoids disappear completely. It is important to note that radiofrequency ablation only works for the internal components of haemorrhoids, hence, if you suffer from external haemorrhoids, these are not treatable by this procedure.

• It reduces the number and symptoms of haemorrhoids and in a significant number of cases causes them to disappear entirely
• It is minimally invasive
• It is quick – the procedure takes approximately twenty minutes
• The recovery time is usually short (but can take longer in some patients)
• You do not need to stay in hospital overnight

All treatments and procedures have risks. The following are the risks of the Rafaelo™ procedure, which will also be discussed with you during your outpatient clinic appointment. 

Problems that may happen straight away

There is a spectrum of symptom severity patients may experience during the recovery. 

• Discomfort around the back passage  
• Most patients develop a degree of urgency of needing passing stool (defaecation) after the procedure. This usually lasts 3 to 5 days. Some patients can develop spasm of the anal closing muscle (sphincter), which on occasion is treated with Diltiazem cream. 
• A small amount of discharge 
• Around one third of patients experience no pain and do not need to take any painkillers. 
• About 60% of patients (six people in every ten) experience mild to moderate pain and need to take paracetamol and ibuprofen in combination for up to a week. They can experience urgency of defecation and pain on opening the bowels, as well as intermittent bleeding, usually on opening the bowels. 
• 10% of patients (one person in every ten) can have more severe pain than this, requiring a combination of paracetamol, ibuprofen and dihydrocodeine. They find the recovery more difficult, but I usually pleased to have had the procedure done afterwards. 
• It is hard to predict which category patients will fall into before the procedure.  
• 2% of patients (two persons in every one hundred) can develop severe pain after the procedure, requiring the use of strong painkillers like morphine (opiates). 
• Bleeding: a small amount of daily bleeding for approximately five to seven days after the procedure is expected. Around 2 % of patients (two persons in every one hundred) develop severe bleeding (defined as more than 200 mL estimated over a 24-hour period). If this happens, you are advised to come to the Emergency Department at UCLH, or if you feel that the bleeding is too much and are concerned. 
• About 5% of patients (one person in every twenty) will need further assessment after the procedure, either in the clinic or an A&E setting, usually for pain or bleeding occurring at 1 to 2 weeks after the procedure. In rare cases, an examination under general anaesthetic and placement of a suture is required (2%) 
• Thrombosis of haemorrhoids, where the blood can clot inside the haemorrhoidal tissue causing severe pain (this is rare). You are advised to contact us directly, visit your GP or come to the Emergency Department if you encounter severe pain after the procedure 

Problems that may happen later

• There is a roughly 15% rate of recurrence of haemorrhoidal symptoms (such as bleeding or prolapse) after a Rafaelo™ procedure requiring retreatment. Often, the treatments take the form of a minor procedure such as further banding or injections. 
• Further procedures may be needed to treat other haemorrhoids.

Problems that are rare, but serious

Very rarely patients may develop infections in the area of the procedure, which can sometimes take a while to heal.

If you decide not to choose this treatment your surgeon will be able to explain alternative treatment(s) based on the severity of your haemorrhoids.

Depending on the severity of your haemorrhoids, other available surgical procedures include ligation, phenol injection, surgical excision and staple haemorrhoidectomy.

You may be asked to use a phosphate enema on the morning of the procedure (you will be told how to use this). You will also be asked not to eat for at least six hours before the procedure is scheduled. You can drink water for up to two hours before the procedure is scheduled. Please take your regular medication with water. 

Please arrive at the hospital half an hour before your appointment. Please arrange for an escort to take you home and stay with you overnight.

We want to involve you in all the decisions about your care and treatment. If you decide to go ahead with treatment, by law we must ask for your consent and will ask you to sign a consent form. This confirms that you agree to have the procedure and understand what it involves. Staff will explain all the risks, benefits and alternative treatments before they ask you to sign a consent form. If you are unsure about any part of your proposed treatment, please speak with a senior member of the team.

The Rafaelo™ procedure can be performed under local anaesthetic in certain patients, but some find it easier to have it under sedation. General anaesthesia is not recommended, as it is important to have the patient partially awake so that they can tell the treating surgeon if they start feeling heat or discomfort from the radiofrequency energy as it is being applied. If so, the surgeon can stop applying the radiofrequency energy and cool down the tissues with a cold compress to avoid causing a burn to the anal skin next to the haemorrhoid.

The surgeon will insert a small device into your back passage called a proctoscope. This will allow them to examine the haemorrhoids. The surgeon will inject the haemorrhoids with a special device that will deliver the radiofrequency ablation to treat the haemorrhoid. This will take a few seconds. After the haemorrhoids are treated, you will be able to leave once you have recovered from the anaesthetic.

After the procedure you may need to take some basic pain medication which you can purchase over the counter. You may experience mild discomfort and discharge from the back passage.

You can then leave with your escort. The recovery time from the procedure normally takes between one to seven days.

This depends on the severity of the haemorrhoids. You may be able to return to work a day after the procedure. However, we will issue a fitness to work certificate for a week. We will see you again in our clinic between six and eight weeks later.

You may experience some minor bleeding. If the bleeding is worrying, you or does not stop within 24 hours of going home please do one of the following:

• visit your GP 
• go to the nearest Emergency Department 
• contact us during working hours on the number in the Contacts section below

You are welcome to discuss this procedure with one of our experienced surgeons who will perform the operation. We will be happy to answer any questions you may have.

1. Subramonia S, Lees T. Radiofrequency ablation vs conventional surgery for varicose veins - a comparison of treatment costs in a randomised trial. Eur J Vasc Endovasc Surg. 2010 Jan. 39(1):104-11. 
2. Shepherd AC, Gohel MS, Lim CS, Hamish M, Davies AH. Pain following 980-nm endovenous laser ablation and segmental radiofrequency ablation for varicose veins: a prospective observational study. Vasc Endovascular Surg. 2010 Apr. 44(3):212-6.

Telephone (Monday to Friday 09:00-17:00)
Direct line: 020 3447 7059
Switchboard: 08451 555 000 / 020 3456 7890 ext. 77059
E-mail: uclh.colorectal.surgery@nhs.net

Address: Colorectal Surgery Department, 250 Euston Road, London, NW1 2PG