Novel Technique: Radiofrequency Coagulation -- A Treatment Alternative for Early-Stage Hemorrhoids

Pravin J. Gupta, MS [Gen. Surgery]

Disclosures

Medscape General Medicine. 2002;4(3) 

In This Article

Abstract and Introduction

Abstract

Background. For early-stage hemorrhoids, in which bleeding is the primary symptom, conventional approaches to management include injection of sclerosing solutions, band ligation, and infrared coagulation. In our study, we used the radiofrequency coagulation technique as an alternative strategy to treat early-stage hemorrhoids.
Materials and Methods. A total of 210 patients with bleeding hemorrhoids were treated with radiofrequency coagulation at the Gupta Nursing Home in Nagpur, India.
Results. Follow-up was at 2 weeks, 3 months, and 12 months after procedure. Results were recorded as follows: (1) Bleeding - Twenty-eight (13%) patients had recurrence of bleeding during the observation period. (2) Pain - Some degree of discomfort was reported by all patients within the first 48 hours. (3) Retention of urine - Only 1 patient had retention of urine; this patient was 74 years old and had an enlarged prostate. (4) Discharge - Thirty-four (16%) patients complained of discharge in the first 2 weeks after procedure. (5) Return to work - Seventy percent (n = 145) of patients resumed their duties after 48 hours; the remainder required 1 additional day. (6) Sepsis - There were no reports of postprocedure sepsis. (7) Sphincter function - None of the patients experienced problems with continence or stenosis. Overall patient satisfaction was 84% (n = 177).
Conclusion. Although these initial results of coagulation of hemorrhoids by radiofrequency appear quite exciting and encouraging, long-term follow-up is needed to assess the duration of relief and potential side effects. Continued work in this area will likely provide promising new dimensions in the effective management of early-stage hemorrhoids in which bleeding is the main symptom. A separate, randomized trial was carried out to assess the difference in efficacy between infrared coagulation and radiofrequency coagulation in 100 patients with early-stage hemorrhoids. Radiofrequency coagulation was found to be more effective than infrared coagulation in terms of recurrence of bleeding, asymptomatic recurrences of hemorrhoids, and overall satisfaction of technique.

Introduction

The term "hemorrhoids" refers to a common condition occurring worldwide. This condition affects both sexes equally, and although seen more commonly in adults and the elderly, it also affects children.

Because hemorrhoids have a complex and controversial etiology, with different degrees or stages and locations of pathology, no single mode of therapy has proven completely effective. A number of different modalities of treatment have been put forward in accordance with advancements in the fields of surgery and biomedics.

In early-stage hemorrhoids, where bleeding is the primary symptom, bipolar, infrared, and laser coagulation are currently used by practitioners worldwide. These techniques involve the application of bipolar current or infrared or laser light to cause coagulation and necrosis, which then leads to fibrosis in the submucosal layer.[1] These techniques are generally effective for internal hemorrhoids of grades I and II. Use of rubber-band ligation, sclerotherapy, cryosurgery, and direct-current probe are in practice for the same purpose.[2]

The aim of this study was to assess the utility of radiofrequency coagulation for the treatment of early-stage nonprolapsing hemorrhoids as an alternative to the traditional methods discussed above.

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