Feasibility of delivering radiofrequency treatment for haemorrhoids in the outpatient setting: Our initial experience

Published Date: 30th August 2025

Publication Authors: Rajendiran. A, Maharjan. A, Becker. S

Aim: RAFAELO has emerged as a novel option for grade 2 and grade 3 haemorrhoids, being minimally invasive. Most studies in the UK have focused on performing RAFAELO under general anaesthesia or sedation, limiting its accessibility. However, our unit is pioneering a significant shift by conducting the first UK-based study of RAFAELO in an outpatient setting. This approach improves patient convenience and significantly reduces the waiting time for the procedure. By evaluating its feasibility, safety, and efficacy in an outpatient context, we aim to broaden the applicability of this technique and optimise haemorrhoid management for a wider patient population.

Methods: This prospective study evaluated outpatient RAFAELO for grade 2-3 haemorrhoids. Symptomatic haemorrhoids refractory to conservative treatment were included. Exclusion criteria were grade 1/4 haemorrhoids and patient preference. The advantage of our study is our extended inclusion criteria comprising patients with ASA 3/4 and patients on anticoagulants. The procedure was performed under local anaesthesia in a dedicated haemorrhoid clinic. Haemorrhoid symptom score and EU-5D-5L score were used to measure quality of life. Patients were followed up at 2-4 and 12 months.

Results: 53 patients were included. M:F ratio was 1.5: 1. 33.9% (n = 18) patients were ASA 3/4. 35.8% (n = 19) patients had more than two attempts at banding. 3.7% (n = 2) had previous excisional haemorrhoidectomy. Bleeding was the main symptom (100%) followed by prolapse (43.3%). 62.2% patients (n = 33) achieved symptom resolution with one sitting of RAFAELO however 42.6% (n = 23) had recurrence of symptoms and required further sittings. 11.3% (n = 6) went on to have definitive surgery such as Transanal Haemorrhoid artery De-arterialisation (THD) or excisional haemorrhoidectomy.

Conclusion: This is the first UK based study to demonstrate the feasibility of RAFAELO in the outpatient setting. We found RAFAELO to be a promising bridging procedure between banding and definitive surgery.

Rajendiran, A.; Maharjan, A. et al. (2025). Feasibility of delivering radiofrequency treatment for haemorrhoids in the outpatient setting: Our initial experience. Colorectal Disease. 27(S1), p.e70174. [Online]. Available at: https://doi.org/10.1111/codi.70174 [Accessed 5 November 2025].

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