Feasibility and advantages of delivering radiofrequency ablation treatment for haemorrhoids under local anaesthesia in the outpatient setting in the UK: our initial experience.

introductionRadiofrequency ablation (RFA) for haemorrhoids has emerged as a minimally invasive treatment for grade II-III haemorrhoids, offering reduced postoperative pain and faster recovery compared with conventional surgery. However, most published data describe the procedure in theatre under general anaesthesia, limiting accessibility and increasing costs.

methodsWe conducted a prospective evaluation of radiofrequency ablation performed under local anaesthesia in an outpatient setting for patients with grade II-III haemorrhoids refractory to conservative therapy for a period of 2 years between 2022 and 2024. Procedures were performed using the RAFAELO

resultsIn total, 53 patients were included in the study with median age of 58 years. A total of 33.9% of patients were ASA 3/4; seven of these patients were on anticoagulants, and their medications were stopped according to the British Society of Gastroenterology (BSG) guidelines. All the patients were able to complete the procedure under local anaesthetic in outpatient setting. All procedures were completed under local anaesthesia with same-day discharge and no major complications. Median follow up was 135 days. At 2-4 months, significant improvement in HSS was observed (mean difference 9.50; 95% CI 5.34-13.66; p < 0.001). The 12-month findings (n = 11) suggested possible persistence of benefit but are limited by substantial attrition and symptom-driven follow-up and should not be generalised. The quality-of-life scores (EQ-VAS) showed a 63% improvement between preoperative and 2-4-month values (p < 0.001). No statistically significant improvement was observed at 12 months within the remits of a small symptom-selected sample (n = 11). In total, six patients (11.3%) required subsequent operative intervention. None of the patients who were on anticoagulants had any bleeding complications or any unplanned return to tertiary care.

conclusionsOur experience demonstrates that radiofrequency ablation treatment for haemorrhoids can be safely and effectively delivered in an outpatient setting under local anaesthesia, even among higher-risk patients. The study demonstrates encouraging short-term symptom improvement, but the limited and selective long-term data preclude firm conclusions regarding durability or broader service impact. Larger, controlled studies with structured long-term follow-up are required to define the role of outpatient RFA within haemorrhoid care pathways.