Radiofrequency Ablation for Hemorrhoidal Disease

Hemorrhoidal disease is a common anorectal condition that may require treatment when bleeding, prolapse or persistent symptoms fail to respond to conservative or office-based therapy. Radiofrequency ablation (RFA) has emerged as a minimally invasive, tissue-sparing technique for symptomatic internal hemorrhoids, based on controlled delivery of high-frequency energy into hemorrhoidal tissue. The resulting thermal effect induces coagulative necrosis, fibrosis, mucosal fixation and progressive reduction in hemorrhoidal volume, without excisional removal of anoderm or rectal mucosa. This narrative review summarizes the mechanism, technical principles, clinical advantages, comparative evidence and remaining uncertainties surrounding RFA, with particular attention to the Rafaelo procedure and related radiofrequency-based approaches. Current evidence suggests that RFA may reduce postoperative pain, analgesic requirements, wound-related morbidity, hospital stay and time to return to normal activity compared with conventional hemorrhoidectomy, while maintaining acceptable short- and mid-term symptom control in selected patients, especially those with grade II-III internal hemorrhoids. However, available studies remain heterogeneous in design, technique, patient selection, outcome definitions and follow-up duration. The relationship between modern probe-based RFA and earlier radiofrequency-based approaches, including Ellman surface coagulation, Celon bipolar radiofrequency-induced thermotherapy and radiofrequency-assisted hemorrhoidectomy, remains insufficiently standardized in the literature. Further randomized trials, standardized outcome reporting, long-term recurrence data and cost-effectiveness analyses are required to define the optimal indications and therapeutic position of RFA.