The Rafaelo® Procedure at Cardiff and Vale Hospitals

What is the Rafaelo procedure?

The Rafaelo procedure is a quick, minimally invasive treatment for internal haemorrhoids that uses radiofrequency energy, a safe, targeted form of heat, to shrink the swollen tissue from within. It's usually done under local anaesthetic, without any cuts or stitches, and most people go home the same day.

What conditions does it treat?

The Rafaelo procedure is used to treat:

• internal haemorrhoids graded 1 to 3, causing symptoms such as bleeding, itching, discomfort or mild prolapse
• haemorrhoids that haven't settled with dietary changes, over-the-counter treatments or medication from your GP
• some grade 4 haemorrhoids, where it may reduce symptoms, though it's unlikely to fully resolve them, and surgery is usually still needed for these.

It's not suitable for haemorrhoids that are mostly external, since the outer skin around the anus contains pain-sensitive nerve endings that the treatment can't safely target.

What are the benefits of having the Rafaelo procedure?

Because the treatment doesn't cut or remove any tissue, it avoids much of the pain and lengthy recovery associated with traditional haemorrhoid surgery. Internal haemorrhoid tissue has no pain-sensitive nerve endings, so many people feel little more than warmth or gentle pressure during treatment and can return to normal activities the same day or the day after.

Are there different types or surgical approaches?

The Rafaelo procedure always works the same basic way: a fine probe delivers radiofrequency energy directly into the haemorrhoidal tissue, causing the blood vessels inside to seal shut so the haemorrhoid shrinks over the following weeks.

It can be performed under local anaesthetic alone, with light sedation or gas and air added for comfort, or, less commonly, under general anaesthetic if you and your surgeon prefer this. Larger haemorrhoids can sometimes be treated in stages over more than one session.

It's one of several treatments for haemorrhoids: others include rubber band ligation, a similar procedure that ties off the arteries feeding the haemorrhoid using stitches, and, for more severe or external haemorrhoids, surgical removal. Your surgeon can explain which option best suits the grade and position of your haemorrhoids.

What happens before the operation?

Before your procedure:

• you'll have an examination, usually including a proctoscopy, where a small, lit tube is used to look at the size and position of your haemorrhoids and rule out other conditions
• your surgeon will confirm whether the Rafaelo procedure is suitable, or discuss alternatives if it isn't
• you can usually eat and drink as normal beforehand
• it's worth avoiding constipation before your appointment by staying hydrated and keeping up your fibre intake
• if you're having sedation, you'll need to arrange for someone to take you home afterwards
• your surgeon may ask about your general health, and may request routine blood tests or scans, or advise on stopping smoking or losing weight beforehand if relevant.

What happens during the procedure?

A typical Rafaelo procedure follows this pattern:

1. You lie on your side with your knees drawn up towards your chest.
2. A lit proctoscope is gently inserted so your surgeon can see your haemorrhoids clearly.
3. Local anaesthetic is injected around the haemorrhoid.
4. A fine probe is inserted a short distance into the haemorrhoid tissue.
5. Your surgeon delivers controlled radiofrequency energy through the probe, heating the tissue so its blood supply seals shut.
6. The probe is removed; no cuts or stitches are needed, and the whole procedure usually takes between 15 and 30 minutes.

What does recovery look like?

The Rafaelo procedure is usually done as day surgery. Most people go home within a few hours, and can drive themselves home if they've only had a local anaesthetic.

Little or no pain relief is usually needed afterwards; some people take paracetamol or ibuprofen for a day or two, while others need nothing at all. Many people notice their symptoms ease almost immediately, though the haemorrhoid itself continues to shrink over the following weeks, and it can take up to 6 weeks for it to fully settle.

A small amount of bleeding or spotting is normal for up to 2 weeks. You may also feel an urgent need to open your bowels for a day or two afterwards, even when nothing comes out; this is caused by the treatment temporarily stimulating nerves nearby and settles on its own. Avoid heavy lifting or strenuous exercise for 48 hours, and a high-fibre diet with plenty of fluids helps both healing and reduces the chance of haemorrhoids returning.

You'll usually have a follow-up appointment around 4 weeks later to check your recovery.

What are the risks and complications?

The Rafaelo procedure has a low rate of serious complications, but possible risks include:

• mild discomfort, burning or swelling around the treated area, usually short-lived
• light bleeding or spotting for up to 2 weeks; around 4 in 100 people have heavier bleeding, either within the first 48 hours or 10–14 days later
• temporary mucus discharge
• a small risk of infection
• rarely, an anal fissure, a small tear in the lining of the anal canal, causing sharp pain when opening your bowels
• haemorrhoids returning in the future, particularly if constipation or straining continues; this can be treated again if needed.