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

Pravin J. Gupta, MS [Gen. Surgery]

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In This Article

Results

Patients were followed up after 2 weeks to obtain information regarding pain, bleeding, and anal discharge (Figure 3). Follow-up was repeated at 3 months and at 12 months to collect data on anal stenosis, anal incontinence, recurrence of hemorrhoids, and degree of relief experienced by patients. Proctoscopic examination was not done in the first follow-up to avoid causing discomfort and injury to the healing tissues. Proctoscopic examination was performed during subsequent follow-up at 3 months and 12 months. Findings during follow-up are discussed below.

Figure 3.

Findings at follow-up 2 weeks after procedure.

Observations at 2-Week Follow-up

Bleeding. Eighteen patients reported bleeding during this period of observation (12 patients had bleeding during week 1 after procedure; 6 during week 2). Of these 18 patients, 1 had very heavy bleeding, requiring a second procedure.

The main reason for the bleeding was sloughing of the pile mass before complete healing. Incomplete destruction of the entire mass also resulted in bleeding. No specific treatment was advocated, as none was necessary.

Pain. All patients reported some degree of discomfort in the first 3 days after procedure, which was relieved by administration of appropriate analgesics; no other use of analgesics was required. (After noting this common complaint during follow-up, it is now our practice to prescribe analgesics such as rofecoxib in appropriate doses, twice daily, for the first 5 days after the procedure.) Pain was more commonly reported among patients who had larger hemorrhoids or in whom coagulation was done close to the dentate line.

Retention of urine. One patient experienced retention of urine. However, this patient was 74 years old and had an enlarged prostate. He was catheterized and was relieved; he had no difficulty urinating thereafter.

Discharge. Thirty-four (16%) patients complained of discharge in the first 2 weeks. This complication was attributed to the sloughing of the coagulated hemorrhoidal mass because it was observed that patients with second-degree hemorrhoids experienced discharge more often than did patients with first-degree hemorrhoids.

Return to work. Seventy percent of patients resumed their duties (employment or routine daily work) after 48 hours; the remaining 30% required 1 or 2 additional days.

Sepsis. There were no reports of postprocedure sepsis.

Observations at 3-Month Follow-up

Six patients were lost to follow-up during this period.

Bleeding. Two patients had recurrence of bleeding. In both cases, the procedure was repeated and the complication successfully resolved.

Proctoscopy. The site where coagulation was done appeared pale and flat, indicating satisfactory and successful coagulation (n = 203).

There were no reports of pain, discharge, or discomfort.

Observations at 12-Month Follow-up

Another 11 patients were lost to follow-up during this period.

Bleeding. Eight patients experienced bleeding during this follow-up period. These patients were different from those observed in the previous 2 intervals (2 weeks and 3 months) who underwent repeat procedure, in that 3 of these 8 patients refused to undergo repeat treatment. The remaining 5 patients underwent repeat procedure and the complication was resolved.

Asymptomatic recurrence. On proctoscopic examination, 18 patients were found to have varicosities at the site of treatment, but they were free of any symptoms. No specific treatment was advised. A mild laxative was suggested to keep the stool soft.

There were no reports of incontinence or stenosis.

Overall efficacy of the procedure. More than 84% of patients experienced near total relief from their symptoms, including anal bleeding, pain, and itching. All patients achieved good fecal continence. The latter has resulted in perceptible improvement in quality of life. (Quality of life was assessed by questionnaire and addressed parameters such as improvement in general health, increase in appetite, increased sense of well-being, and ease of defecation.) Obliteration of the treated hemorrhoids, as confirmed by anoscopy, was as high as 89%.

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