Propensity score-matched comparative study of radiofrequency ablation (with the Rafaelo device) versus hemorrhoidectomy for the treatment of grades II-III internal hemorrhoids.

Abstract

Purpose: Hemorrhoidal disease impacts quality of life, with hemorrhoidectomy being the standard treatment for grades II-III hemorrhoids. Radiofrequency ablation (RFA) using the Rafaelo technique offers a less invasive alternative; however, comparative data remain limited. This study evaluated short-term outcomes following RFA versus conventional hemorrhoidectomy.

Methods: A single-center retrospective cohort study was conducted at a medical university hospital in Thailand, involving patients who underwent either RFA or hemorrhoidectomy between January 2023 and September 2024. Propensity score matching was utilized to minimize selection bias. Primary outcomes were postoperative pain and opioid consumption.

Results: After propensity score matching, 102 patients were analyzed (51 patients in each group). Baseline characteristics were well-balanced between the 2 groups. The RFA group had higher pain scores at 8 hours postoperatively (1 vs. 0, P=0.002) but lower scores at 20 hours (0 vs. 1, P<0.001). Opioid consumption was significantly lower in the RFA group (9.8% vs. 31.4%, P=0.007), with a reduced morphine-equivalent dose (0.7 mg vs. 3.5 mg, P=0.003). Additionally, the RFA group had a shorter operative time (20 minutes vs. 30 minutes, P<0.001) and less intraoperative blood loss (0 mL vs. 5 mL, P<0.001). Hospital stays and complication rates were comparable between groups.

Conclusion: RFA resulted in improved postoperative pain control, reduced opioid use, shorter operative duration, and decreased blood loss compared to hemorrhoidectomy, with similar hospital stay durations and complication rates.