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

Pravin J. Gupta, MS [Gen. Surgery]

In This Article

Comparison of Radiofrequency Coagulation With Infrared Coagulation for the Treatment of Hemorrhoids

Encouraged by the satisfactory results we obtained with the radiofrequency coagulation procedure, we carried out a separate study to compare the efficacy of this technique with that of infrared coagulation.

One hundred patients with first- and second-degree bleeding hemorrhoids were examined; 50 were treated by radiofrequency coagulation and 50 by infrared coagulation. These patients were randomized prospectively to the 2 treatment groups. Randomization was done by sealed envelope which was opened by the surgical nurse upon patient's arrival for treatment; results were blinded.

Infrared coagulation was done at the pedicle of all 3 principal positions of hemorrhoids -- that is, at the 3-, 7-, and 11-o' clock positions, in the same session. In contrast, radiofrequency coagulation was done directly over the pile masses, at similar positions.

Findings from follow-up of patients after 2 weeks are summarized in Figure 4.

Figure 4.

Comparative findings at 2 weeks: radiofrequency coagulation (RFC) vs infrared coagulation (IRC).

The higher incidence of pain associated with radiofrequency coagulation is due to the direct coagulation of the hemorrhoids, which may reach up to the dentate line. The duration of the coagulation and the area coagulated in the radiofrequency technique are greater than in infrared coagulation, where only 3 or 4 spot welds of the coagulator are made at the pedicle of the hemorrhoids.

Similarly, the increased frequency of discharge per anus in the setting of radiofrequency coagulation is due to the greater degree of coagulation of the pile mass; thus there is more tissue destruction than in infrared coagulation. Nevertheless, this same phenomenon has helped reduce the incidence of postprocedure bleeding and development of asymptomatic recurrences that are more frequently seen after infrared coagulation.

Data from further follow-up at 1 year are shown in Figure 5. Based on these collective findings, radiofrequency coagulation appears to have benefit over infrared coagulation with respect to recurrence of bleeding, asymptomatic recurrences of hemorrhoids, and overall satisfaction of technique.

Figure 5.

RFC vs IRC: Data from 1-year follow-up.