HEMORRHOID EXCISION USING RADIOFREQUENCY

RADIOFREQUENCY ABLATION AND MUCOPEXY FOR ADVANCED HEMORRHOIDS

The conventional surgical techniques for hemorrhoids involve some or other form of excisional maneuver, with their accompanying complications. Radiofrequency ablation and circumferential mucosal plication is a method that would fix the prolapsing mucosa to its normal position while abolishing its vascular components without resection, thereby minimizing the complications related with excisional procedures.
Radiofrequency ablation causes immediate reduction of vascular components of the mucosa followed by its tethering to the underlying tissue with subsequent healing by fibrosis. This is possible because of the cellular molecular dissolution of the tissue cells, which are exposed to the radiofrequency waves. The sensory nerve endings in the treated area are destroyed with radio ablation, minimizing postoperative pain.

Mucosal plication with anal encircling is a procedure used for rectal prolapse in some parts of the world. On comparison, the benefits of plication of prolapsing mucosa after radiofrequency ablation over the standard ligature and excision techniques are quite encouraging. Our technique requires a significantly less time to perform in comparison to the ligature and excision.
The ablation and plication achieves two major goals, which are needed to tackle hemorrhoids prolapse; 1) it helps fixation of the redundant mucosa to the underlying internal sphincter, and thus arrests its prolapse, 2) it minimizes the blood flow by eliminating the submucosal vascular components.
. While in the radiofrequency ablation and plication procedure, the tissue under treatment lies well below the dentate line, thereby reducing the pain quotient significantly. The absence of external wound is another factor, which minimizes the pain.
In recommending this combination technique, a question maybe asked as to whether radiofrequency ablation is the key component of the procedure or is it the suture plication that does the work. Even the need for performing the radiofrequency ablation may be called in question. In our opinion, the combination is complimentary to each other. Though radio ablation takes care of the vascular components of the prolapsing mucosa by way of coagulation and cicatrisation, it cannot effectively fix the redundant mucosa back to their positions, but the same is ably anchored by the plication procedure. The hybrid procedure ensures a complete control of the mucosal prolapse and
External hemorrhoids(intermucosal prolapse) is defined as a circumferential descent of ano-rectal mucosa through the anus. It differs from the complete hemorrhoidal prolapse in the sense that in complete hemorrhoidal prolapse, the entire thickness of the rectal wall is extruded and there is gross disruption of the anal sphincters. It also differs from the third or forth degree hemorrhoids, where there is a segmental prolapse of the hemorrhoidal tissues namely at 3,7 and 11’O clock positions.
The symptoms produced by hemorrhoids are quite identical to the symptoms of advanced hemorrhoidal disease including pain, bleeding, mucus discharge, and pruritus. The diagnosis can be confirmed by ano-rectal examination.