Another NHS Trust to offer The Rafaelo Procedure

We are delighted to announce the addition of Northern General Hospital, part of Sheffield Teaching Hospitals NHS Foundation, to the growing list of Rafaelo providers. Led by Colorectal Consultant, Mr A Harikrishnan FRCS, Rafaelo is now being offered routinely to those suffering from haemorrhoids who might otherwise have had to undergo far more invasive treatment options.

UKSkin is the latest private clinic to offer The Rafaelo Procedure

UKSkin, a privately owned cosmetic and surgical clinic in Birmingham, has just launched The Rafaelo Procedure from their state of the art King’s Heath site. Administered by two of the regions leading colorectal surgeons, Mr Nigel Suggett FRCS and Mr Amit Patel FRCS, the clinic will offer regular treatment dates. We are delighted to welcome UKSkin to our growing list of Rafaelo clinics and we look forward to supporting them.

New treatment for Fistulas about to be launched!

We are soon to launch Fistura, a brand new radio frequency based treatment to deal with Fistulas, a very common problem which up until now has required invasive surgery. Shortly, all surgeons offering Rafaelo will also be able to offer Fistura from their clinics. The website will soon go live!

Another BMI to offer The Rafaelo Procedure

Today we were delighted to attend a list at BMI Clementine Churchill Hospital in Harrow with Mr Jason Smith FRCS from where he intends to offer The Rafaelo Procedure as a routine treatment.

Clinics to resume Rafaelo Treatments in June

LATEST NEWS – We are delighted to announce that Rafaelo Procedures are slowly being re-introduced. Initially, two private clinics in London will be offering Rafaelo from the beginning of June and we expect others to follow suit shortly thereafter. We will update you when more clinics start to resume their treatment offerings, although we anticipate that Rafaelo in the NHS might still be a way off. If you are interested in having The Rafaelo Procedure, please complete one of our on-line forms with your contact details and we will respond with available dates and venues. Stay safe and well.

Government indicates that elective surgery might start up again very soon

With two months of zero elective surgery being carried out throughout the UK, indications today are that some hospitals are starting to re-introduce elective surgery. That, in time, will include Haemorrhoid treatment. Of course the more urgent cases involving cancers etc will be the first to be introduced but some surgeons are already starting to offer less urgent procedures. We anticipate that many people have been suffering their haemorrhoids during this lock-down period – their diet may have changed, their exercise pattern may have changed and indeed more people may have been spending more time sitting around and that in itself might have impacted on their haemorrhoidal symptoms.

As we anticipate a rush in the pubs and shops as they begin to open up over time, so we would anticipate a rush for people to get treated those conditions they have been suffering.

We at Rafaelo will be formulating a waiting list for those keen on treatment and, as soon as the surgeons re-open their doors, we will feed them with those names who have expressed interest during this period, on a first come first served basis. So, if you are likely to be seeking treatment once we get going again, why not register your interest with us now (by completing one of our online contact forms) and we will ensure that your name is put forward to your local surgeon when the time comes.

Keep safe and keep well.

HSJ Journal

The Guardian

Mr Giovanni Tebala, consultant colorectal, upper GI & laparoscopic surgeon, based in Reading, Windsor and Slough, briefly explains why Rafaelo is so efficient and effective for his patients

Rafaelo® Procedure: a fast and effective new treatment of haemorrhoids


Published: 25/10/2019 | Updated: 21/02/2020


Around 50% of adults experience haemorrhoids by the age of 50. Most of the time, they go away on their own, but if your haemorrhoids are persistent or reoccurring, you may want to consider this new treatment available. Mr Giovanni Tebala, a consultant colorectal, upper GI & laparoscopic surgeon based in Reading, Windsor and Slough, offers this treatment and briefly explains why it’s so efficient and effective for his patients.


Image of an operation


What is the Rafaelo® Procedure?

The Rafaelo procedure is a new and effective procedure to treat the so-called haemorrhoidal disease. It’s minimally invasive and aims to shrink the engorged haemorrhoidal cushions with the use of radiofrequency energy.


Who needs the Rafaelo® procedure?

The Rafaelo procedure can be used on any patient with haemorrhoids. The particular nature of the Rafaelo treatment makes it suitable mostly for patients with first or second degreehaemorrhoids (internal haemorrhoids), although good results have been obtained also in some patients with third and fourth degree haemorrhoids.


What does the Rafaelo® procedure involve?

The Rafaelo procedure can be performed under local, regional or general anaesthesia. Clearly, the advantages of mini-invasiveness can be appreciated mostly if the patient is under local anaesthesia, with or without a minimal sedation. In these conditions, the patient should be able to leave the hospital a few minutes after the procedure.


A small proctoscope is inserted into the anus and, once the haemorrhoids to be treated have been identified, a radiofrequency probe is inserted into each cushion and activated for a few seconds. This energy causes shrinkage of the haemorrhoids and produces a minimal amount of scar tissue that fixes the haemorrhoids to the underlying tissues and eventually reduces the prolapse component.


The operation takes less than 20 minutes and can be associated to other procedures such as colonoscopy, Botox injection, manual proctopexy, partial haemorrhoidectomy and excision of skin tags.


Are there any risks of complications with the Rafaelo® procedure?

Each and every surgical procedure has a risk of complications. Untoward side effects and complications can happen also with Rafaelo, but the risk is very low.


Anal discomfort and discharge for few days are common side effects, but usually they don’t interfere with the patient’s everyday activities and can be easily tolerated.


Much more rarely, the patient can develop a perianal infection that may need antibiotics and/or drainage.


Minimal bleeding is possible 5-10 days after the procedure, but usually it is self-resolving and shouldn’t be of much concern.


How long does recovery take?

Immediately after the procedure the patient is able to go to the recovery room, if they had general anaesthesia or sedation. Otherwise, they can go straight to their room.


Post-procedure pain is usually minimal and well tolerated with common non-opioid pain-killers. We always suggest at least 24-48 hours of rest at home before going back to work, but patients should be able to restart their normal activities very soon after the procedure.


The full article is available by clicking this link.


Stapled Haemorrhoidectomy

Many individuals around the globe will suffer from haemorrhoids at some stage in their lives, particularly as they get older. Haemorrhoids – swollen veins in the anal or rectal area – occur when too much strain is placed on haemorrhoidal cushions, causing them to become inflamed, swell, and sometimes even bleed.

In most cases, haemorrhoids can be dealt with effectively through home remedies or over-the-counter solutions. However, in more extreme cases, surgery is required.


What exactly is a stapled haemorrhoidectomy?

Stapled haemorrhoidectomies (or haemorrhoidopexies) are most often used to treat third-degree haemorrhoids, which protrude from the anus as a result of straining during a bowel movement. A stapled haemorrhoidectomy procedure doesn’t actually remove haemorrhoids themselves, but instead, the loosened, expanded tissue around them is pinned back, halting the prolapsed effect.

“Stapling”, as it’s also known, is a relatively-new approach to treating haemorrhoids, and only became widespread in the late 90s. Some small-scale studies carried out on the procedure concluded that it was less painful than traditional haemorrhoidectomies and also healed faster. It was also suggested that stapling controlled future recurrence of haemorrhoid symptoms just as effectively as traditional approaches, leading to increased popularity and interest in the procedure.


How does it work?

During the stapled haemorrhoidectomy procedure, a hollow, circular tube is carefully inserted into the anal canal, through which a suture is threaded and woven into the anal canal above the internal haemorrhoids – the suture ends are drawn back out of the anus through the tube. A surgical stapler is pushed through the first tube and the lax haemorrhoid tissue below the haemorrhoid is pulled into the stapler’s jaws. When the suture is pulled, the haemorrhoid cushions are returned to their natural position in the anal canal, after which the stapler is triggered, cutting off the circumferential ring of excess tissue, sealing it at the upper and lower edges.


How long does the procedure take?

A stapled haemorrhoidectomy takes less time than a traditional haemorrhoidectomy (roughly half an hour), and is normally much less painful. Those who undergo the procedure are normally able to return to work faster than those on whom a traditional haemorrhoidectomy is administered. If your stapled haemorrhoidectomy is a day procedure, you’ll be able to go home once the anaesthetic has worn off and you can eat and drink comfortably. Patients may need someone to stay with them for 24 hours post-surgery to ensure they remain safe and stable.


Who should have a stapled haemorrhoidectomy?

People suffering from either internal or external haemorrhoids can turn to stapled haemorrhoidectomies as potential solutions to their problems. The procedure is normally used to treat third or fourth-degree haemorrhoids, though it can also be used for second-degree haemorrhoids that extend outside the anus during a bowel movement but retreat again of their own accord. Third-degree haemorrhoids must be pushed back into the anus following a bowel movement, but fourth-degree haemorrhoids will always remain outside and visible.

In some cases, a stapled haemorrhoidectomy can be combined with the removal of the external portion of the haemorrhoid to alleviate the problem, though if the external haemorrhoid is big enough, both the internal and external portions of the haemorrhoid may need to be removed through a traditional surgical haemorrhoidectomy.


Where do the staples go after surgery?

In the course of a stapled haemorrhoidectomy, the blood vessels within the haemorrhoid tissue that feed the haemorrhoid vessels themselves are cut off, effectively reducing the overall size of the haemorrhoid. While the damaged tissue around the haemorrhoid heals following the procedure, the scar tissue locks the haemorrhoidal cushions higher in the anal canal. Once the tissue has healed, the staples simply drop off and are passed in stool. Patients are unlikely to ever notice their staples passing.


Are there any complications with stapled haemorrhoidectomies?

Though stapled haemorrhoidectomies are more popular than ever, they are generally associated with a high risk of recurrence than the forms of haemorrhoid surgery normally performed, primarily because a stapled haemorrhoidectomy only reduces blood flow to loosened tissue rather than removing the haemorrhoid entirely, as would be the case in sclerotherapy, coagulation therapy or haemorrhoidal artery ligation.


The recurrence issue

A review published in The Cochrane Library analysed seven randomised clinical trials in which 537 people participated, the results of which showed that those who had undergone stapled haemorrhoidectomies were much more likely to experience recurrences of the condition than those who had their haemorrhoids removed completely. From a pool of 269 stapling patients, 23 suffered recurrences; in comparison, only four people from the surgical-removal group experienced recurrence of the condition. A substantial number of stapling patients also experienced haemorrhoid prolapse within and beyond a year of their procedures taking place, though the stapling approach was preferable in regard to pain, itchiness and the necessity for bowel movements.

“This study shows that stapled haemorrhoidopexy is associated with a greater risk of hemorrhoid recurrence and the symptom of prolapse in long-term follow-up compared to conventional excisional surgery,” explained Shiva Jayaraman Colquhoun, lead investigator in the study.

A general surgery resident at the University of Western Ontario also commented: “If surgeons are to offer this novel technique to their patients, there should be an informed discussion of the risks.

“This paper directly confronts the major concern with stapled haemorrhoidectomy, namely the long-term outcome,” an MD in private practice added.

“Proponents of this procedure argue it provides similar results to the open procedure with less pain, less disability and more rapid return to work. This paper states that the decreased pain and disability may entail increased risk of recurrence. As the authors note, patients must be advised of this increased risk.”

He concluded: “In all fairness, the increased risk, although statistically significant, is still clinically acceptable, 23 of 269 [stapled] patients versus four of 268 patients with conventional haemorrhoidectomy.

“Physicians and patients will therefore choose between a procedure carrying increased morbidity and disability with a low recurrence rate, and a procedure with decreased morbidity and disability and a higher recurrence rate.”

Which conditions share symptoms with haemorrhoids?

Haemorrhoids are a common condition affecting numerous people around the world every year. Also known as ‘piles’, haemorrhoids are thought to impact the lives of up to 75 per cent of people living in the United States alone, for example, with adults aged between 45 and 65 most often affected by it. The condition can be exacerbated by external factors such as obesity, pregnancy and sexual activity, and they can form both internally and externally to the anal area.

According to Dr. Herbert Lerner, a colon-rectal surgeon, “You often can’t see or feel the internal ones, but straining during bowel movements and constipation can cause these haemorrhoids to bleed and occasionally push through the anal opening.”

Anal bleeding can be quite alarming for anyone, and unfortunately, haemorrhoids aren’t the only condition that cause it. In fact, haemorrhoids share symptoms with several other more serious medical problems.

Common haemorrhoid symptoms in someone who has been diagnosed with haemorrhoids in the past can be treated at home,” explained Jason F. Hall, a colon and rectal surgeon at the Lahey Clinic in Burlington, Mass.

“Any new rectal bleeding or heavy rectal bleeding, especially in someone over age 40, should be evaluated.”

Haemorrhoids can cause significant and uncomfortable itchiness, pressure on the anus, and various degrees of pain, in addition to bleeding. It’s common for patients to feel a lump in the anal region, which can also be alarming.

How might a doctor check for haemorrhoids?

If you experience some of the aforementioned symptoms and fear you may have haemorrhoids, you should visit your doctor as soon as possible for a thorough diagnosis. During the examination, your doctor will need to inspect your anus for a number of potential haemorrhoid red flags, including:

  • Lumps and/or swelling
  • Stool or mucus leakage
  • Anal fissures (small itchy tear in the anus)
  • Skin tags (excess skin left behind after an external haemorrhoid blood clot dissolves)
  • Irritated skin
  • Prolapsed internal haemorrhoids that are visible through the anus
  • External haemorrhoids with a blood clot on the inside

In addition, your doctor may also carry out a digital rectal examination in order to determine the tone of the muscles in the anus, or check for any tenderness or lumps/masses in the rectal tissue.

If any examination on the day proves inconclusive, your doctor may refer you for a more extensive diagnosis procedure, such as a:


Rigid Proctosigmoidoscopy. This is a similar procedure to a anoscopy, in which a medical professional uses a proctoscope to examine the lining of your rectal region, as well as your lower colon. During this inspection, the tissue lining your rectum and lower colon will be assessed to find any indications of issues in the lower digestive tract, as well as hints of bowel disease. This procedure, which normally doesn’t require anaesthesia, can be carried out at your doctor’s office during a second visit, or you may be referred to a hospital or clinic elsewhere.

Anoscopy. In the case of an anoscopy, a medical professional will use an anoscope to inspect the lining of your anus and lower rectum, if required, carefully examining the tissue to identify any signs of bowel disease or lower digestive tract issues. As with a rigid proctosigmoidoscopy, this procedure can be performed at the doctor’s office and doesn’t normally require anaesthesia.

Haemorrhoids can also be diagnosed by a doctor during other procedures, such as colonoscopies or flexible sigmoidoscopies.


Which other conditions can cause haemorrhoid symptoms?

If you’ve tried a number of home remedies or over-the-counter medication and your haemorrhoids continue to cause issues, it’s time to seek medical help. Visit your doctor if you experience any of the following haemorrhoid-related symptoms:

  • Itchiness, pain, pressure or burning sensations that fail to respond to home treatments
  • Rectal bleeding (especially if it’s heavy or doesn’t respond to home treatments)
  • Additional symptoms like weight loss, fever, abdominal pain or a change in bowel movements


Jason F. Hall continues: “Haemorrhoids are common, but haemorrhoids symptoms that do not clear up quickly with home care or that keep coming back do need to be evaluated.

“The best place to start is with your primary caregiver. In many cases, a primary caregiver can make the right diagnosis and start you on the best treatment.

“If you need a diagnostic evaluation by a specialist, you may be sent to a gastroenterologist or a colon and rectal surgeon. If you need any surgical treatment, it should be done by a colon and rectal surgeon.”

When you have a good understand of what conditions produce symptoms similar to those of haemorrhoids, you can determine whether or not you can treat the condition at home first.

In the case of rectal or colon cancer, for instance, a patient may experience persistent bleeding, bowel movement changes, inexplicable weight loss or pain in the lower abdomen. “These cancers can occur near the rectum and cause bleeding and discomfort that are similar to haemorrhoid symptoms,” Hall adds. “Rectal and colon cancer are rare before age 40.”

Anal fissures are another condition that impacts on the anus, causing itchiness, pain, bleeding and a burning sensation. Anal fissures are usually caused by constipation but normally clear up with home treatment. Hall describes them a “small tears, like paper cuts, in the anal canal that can act very much like haemorrhoids.”

Inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn’s disease, is also known to cause bleeding and discomfort in the rectum. IDB normally begins to affect people in young adulthood, and may cause a variety of haemorrhoid-like symptoms such as cramps, weight loss, fever and diarrhea.

Finally, pruritis ani. “This condition is frequently mistaken for haemorrhoids because it causes itching and burning in the rectal area,” says Hall. “It is actually a type of localised dermatitis.” The condition causes a seemingly-unrelenting urge to scratch, and often occurs as a result of an excess of moisture or sensitivity to a kind of food.