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

Pravin J. Gupta, MS [Gen. Surgery]

Disclosures
In This Article

Materials and Methods

This study was conducted at the Gupta Nursing Home in Nagpur, India, from July 1999 to August 2000, and was designed to assess the efficacy of radiofrequency coagulation in the treatment of hemorrhoids. (Ed. Note: For purposes of context, the author indicates that in India, small hospitals are also termed "Nursing Homes." Therefore, such institutions do not exclusively manage elderly patients.) A total of 210 (180 males, 30 females; see Figure 1) of 733 patients initially screened were treated with radiofrequency energy; follow-up was for 12 months. Mean age of patients was 39 years (range, 17-67 years [8 patients were < 20 years of age, 148 were between 20 and 40 years of age, 54 were > 40 years]; Figure 2). No anesthesia was administered other than 5% lidocaine ointment for anal canal lubrication.

Figure 1.

Patient demographics.

Figure 2.

Age distribution of patients.

Diagnosis of Hemorrhoids

Diagnosis of disease was made by rectal and anoscopic examination, and only patients with first- and second-degree internal hemorrhoids were selected for inclusion. All subjects had rectal bleeding, including those with first-degree hemorrhoids with bleeding who had failed to respond to previous conservative treatment (n = 187; previous therapy [mean duration of treatment = 11 months] included laxatives, local anesthetic cream, and drugs such as diosmin).

Patients who had advanced disease (stage III and stage IV hemorrhoids), painful defecation, associated external hemorrhoids, or associated fissure were excluded from the study.

All participants received written explanation of the technique, clearly outlining the potential for relapse and need for repeat procedure. Patients were given the option of selecting any of the other conventional methods of treatment. An informed consent was obtained prior to performing the radiofrequency-based procedure.

Procedure

A laxative (2 tablets bisacodyl) was given the night prior to procedure, and patients were asked to report to procedure with an empty stomach.

A generous amount of 5% lidocaine ointment was applied in the anal canal region and the procedure was begun 10 minutes following this application. (It had been previously established that this 10-minute interval post lidocaine administration was sufficient to reduce sensitivity and permit a comfortable procedure.) Patients were kept in the lithotomy position. A gently inserted proctoscope was sufficient to allow a clear view of the entire anal canal and to locate the hemorrhoids. The long ball electrode attached to a special gun handle provided with the instrument was applied to the hemorrhoidal masses until shrinkage was achieved. The masses were observed to turn dusky white in color as a result of coagulation. Care was taken to keep the operative field free of stool or other coatings to prevent obliteration of the view or accumulation of coagulum over the electrode. Occurrence of the latter may also result in the production of more smoke, which can obscure the operative field.

All hemorrhoids were treated during one session, with care taken to leave normal anal mucosa interspersed to avoid subsequent fibrosis and stenosis.

Postprocedure care. A mild laxative was prescribed for a period of 1 month after the procedure. Warm sitz baths were recommended to relieve pain and discomfort after defecation. All patients were discharged immediately, except for elderly (defined as those older than 55 years of age or with symptoms of prostatism) males who were discharged only after ensuring that they had no problem passing urine.

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