Bipolar radiofrequency-induced thermotherapy of haemorrhoids: a new minimally invasive method for haemorrhoidal disease treatment. Early results of a pilot study

The role of the Rafaelo procedure in the management of hemorrhoidal disease: a systematic review and meta-analysis

BACKGROUND

The aim of this study was to summarize the current evidence regarding the role of the Rafaelo procedure in the management of hemorrhoidal disease (HD).

METHODS

This study was based on the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search was performed (Medline, Scopus, CENTRAL, and Web of Science) from inception to 25/09/2022. Grey literature databases were also reviewed. The primary endpoint was the pooled complications rate of the Rafaelo procedure in patients with HD. Secondary endpoints included short- (bleeding, pain, thrombosis, necrosis, urinary retention, fever, oedema, anal fissure, and readmission) and long-term (stenosis, meteorism, constipation, anal tags, anal hyposensibility, reoperation, and recurrence) postoperative complication rates. Both prospective and retrospective studies were considered. Quality evaluation was performed via the ROBINS-I tool. Certainty of Evidence was based on the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology.

RESULTS

Overall, 6 non-randomized studies and 327 patients were included. The overall complication rate was 17.6% (95% CI 8.8-26.3%). Short-term complications were bleeding (7.5%, 95% CI 2.5-12.5%), thrombosis (2.2%, 95% CI 0.4-4.8%), and pain (1.6%, 95% CI 0.2-3.3%). Reoperation and recurrence rates were 1.8% (95% CI 0.3-3.4%) and 4.8% (95% CI 1.2-8.4%), respectively. A significant improvement in the presenting symptoms was noted. Method approval and patient satisfaction rates were 89.1% (95% CI 81.7-96.6%) and 95% (95% CI 89.8-100%), correspondingly. Overall CoE was "Very Low".

CONCLUSIONS

Further randomized controlled trials are required to delineate the exact role of the Rafaelo procedure in HD.

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.

Assessment of patients' quality of life after haemorrhoidectomy using the LigaSure device

INTRODUCTION

Haemorrhoids are small anatomical structures within the anal canal that are involved in the proper functioning of the lower gastrointestinal tract. Factors favouring the development of haemorrhoidal disease are insufficient physical activity, prolonged sitting and hence a shortage of physical activity, as well as poor diet which lacks adequate amounts of fibre. The main symptom of this disease is bleeding with bright red blood just after defecation. Haemorrhoidal disease occurs when the ligamentous apparatus comes loose and the internal haemorrhoidal plexus translocates down, whereas haemorrhoids enlarge and move out of the anal canal. Haemorrhoidal disease treatment includes conservative, instrumental and surgical therapy.

AIM

To assess treatment and satisfaction in particular life domains after haemorrhoidectomy.

MATERIAL AND METHODS

The research was undertaken in the General, Thoracic and Vascular Surgery Clinic of the 10(th) Military Clinical Hospital with Polyclinic in Bydgoszcz among 50 patients treated due to haemorrhoids and operated on in the period 2007-2008. The study evaluated quality of patients' life after haemorrhoidectomy by Ferguson's method using a LigaSure appliance.

RESULTS

The study investigated whether patients perceived a difference before and after surgery. The research proved that patients can describe disease symptoms and know the risk factors for haemorrhoids. In the studied group patients are able to describe characteristic signs of haemorrhoidal disease and also indicate differences in everyday life before and after the surgery. They can also describe and classify the pain before and 1 year after the haemorrhoidectomy, which was statistically significantly lower already 3 months after the operation.

CONCLUSIONS

Conducted examinations showed that sick people in the precise way were able to determine manifestations and know risk factors of the prevalence of disease hemorrhoidal. Operated sick people indicated the difference in quality of the life both before, as well as after the undergone treatment. After the operation of the haemorrhoids with method of Ferguson using LigaSure apparatus operated sick persons could distinguish and classify pain before the treatment as well as in a year after which was statistically characteristically lower already after three months from treatment.

Haemorrhoids are associated with internal iliac vein reflux in up to one-third of women presenting with varicose veins associated with pelvic vein reflux

OBJECTIVES

To determine the prevalence of haemorrhoids in women with pelvic vein reflux, identify which pelvic veins are associated with haemorrhoids and assess if extent of pelvic vein reflux influences the prevalence of haemorrhoids.

METHODS

Females presenting with leg varicose veins undergo duplex ultrasonography to assess all sources of venous reflux. Those with significant reflux arising from the pelvis are offered transvaginal duplex ultrasound (TVS) to evaluate reflux in the ovarian veins and internal Iliac veins and associated pelvic varices in the adnexa, vulvar/labial veins and haemorrhoids. Patterns and severity of reflux were evaluated.

RESULTS

Between January 2010 and December 2012, 419 female patients with leg or vulvar varicose vein patterns arising from the pelvis underwent TVS. Haemorrhoids were identified on TVS via direct tributaries from the internal Iliac veins in 152/419 patients (36.3%) and absent in 267/419 (63.7%). The prevalence of the condition increased with the number of pelvic trunks involved.

CONCLUSION

There is a strong association between haemorrhoids and internal Iliac vein reflux. Untreated reflux may be a cause of subsequent symptomatic haemorrhoids. Treatment with methods proven to work in conditions caused by pelvic vein incompetence, such as pelvic vein embolisation and foam sclerotherapy, could be considered.