QS113 - Propensity Score Matched Comparative Study of Radiofrequency Ablation (Rafaelo®) vs. Hemorrhoidectomy for the Treatment of Grade 2-3 Internal Hemorrhoids

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Purpose/Background: Hemorrhoid is a common anorectal disease that significantly impacts the quality of life. While surgical hemorrhoidectomy remains the standard treatment for grade 2-3 hemorrhoids, Radiofrequency Ablation (RFA) using the Rafaelo® technique has emerged as a less invasive alternative with the potential to reduce postoperative pain and accelerate recovery. However, comparative data between these two interventions are limited. This study aims to compare the short-term outcomes of Rafaelo® RFA and conventional hemorrhoidectomy in patients with grade 2-3 hemorrhoids.

Methods/Interventions: A retrospective cohort study was conducted at Vajira Hospital, including patients who underwent either Rafaelo® RFA or conventional hemorrhoidectomy between January 2023 and September 2024. Patients treated with Rafaelo® (n=83) and conventional hemorrhoidectomy (n=149) were propensity score-matched based on sex, age, BMI, comorbidities, and hemorrhoidal severity, resulting in 102 matched patients (Rafaelo® n=51, hemorrhoidectomy n=51). The primary outcomes assessed were postoperative pain scores (VAS), opioid use, and length of hospital stay.

Results/Outcomes: After propensity score matching, the baseline characteristics of the two cohorts were well-balanced. The Rafaelo® group had significantly higher pain scores at 8 hours postoperatively (median 1 vs. 0, p = 0.002), while the pain scores at 20 hours were significantly lower in the Rafaelo® group (median 0 vs. 1, p < 0.001). Opioid use was notably lower in the Rafaelo® group (9.8% vs. 31.4%, p = 0.007), and the morphine equivalent dose was significantly reduced (median 0.7 mg vs. 3.5 mg, p = 0.003). There was no significant difference in the length of hospital stay between the two groups (median 1 day, p = 0.392). No differences in postoperative complications were observed between the groups. The mean energy applied per hemorrhoid column during RFA was 1763.22 J.

Conclusion/Discussion: This propensity score-matched analysis suggests that while Rafaelo® RFA did not result in a clinically significant reduction in postoperative pain, it led to a statistically significant decrease in opioid use compared to conventional hemorrhoidectomy for grade 2-3 hemorrhoids. Both techniques showed similar lengths of hospital stay and complication rates. Patients in the hemorrhoidectomy group received more aggressive pain management during hospitalization, while the RFA group required only oral acetaminophen and intravenous morphine as needed. These findings indicate that Rafaelo® may be a preferable option for patients seeking a less invasive treatment with quicker recovery. Further studies are needed to evaluate long-term outcomes.