• Rafaelo for Surgeons

“After over thirty years of General Surgery and twenty years of Colorectal Surgery experience, I am convinced that radiofrequency ablation (RAFAELO) is an appropriate, safe and effective treatment option for 2nd and 3rd degree haemorrhoids, which can be done under local anaesthesia. This is based on my experience of 75 cases within the last two years and after careful audit and patient satisfaction survey, with over six months follow up. I found 90% of my patients confirmed high satisfaction with minimal postoperative pain and early return to work in comparison to traditional Surgical excision. Only 4% of my patients required further procedure, half of whom were planned and staged treatment. Therefore, I currently offer RAFAELO as a first-line option to majority of my patients suffering from haemorrhoids because it is a safe, easy technique and effective short procedure with high success rate.”

Mr Alla Amin MBChB, MS, FRCS (England, Glasgow), FRCS(Colorectal)Consultant Laparoscopic General and Colorectal Surgeon West Herts Hospitals NHS Trust and Spire Harpenden and Bushey private Hospitals.

“As surgeons we have been searching over the centuries for a perfect procedure to control and treat haemorrhoids.  Haemorrhoids are basically varicose veins in the back passage.  They are meant to be there but over time and with constant wear and tear and increased intra-abdominal pressure they get bigger and cause significant symptoms.

Over the years there have been variety of methods to treat haemorrhoids ranging from injection, banding and excisional surgery. Also Halo procedures with various modifications as in ligation and plication.  The fact that we have so many different methods denotes there has been no perfect procedure invented as yet.  However I am happy to say that finally we seem to have hit on an excellent technique to treat most degrees of haemorrhoids without causing much pain or discomfort.  This is the new Rafaelo technique which is using radiofrequency ablation (microwave) surgery to help the haemorrhoids to shrink significantly.  This technique can be carried out under local anaesthesia or light general anaesthesia which is preferred by the majority of patients.  It is a quick application technique taking on average between 15 minutes to carry it out.  It is done as a day case without much preparation and the patient can walk home a couple of hours later.  So far I have performed approximately 16-20 cases and I am so impressed by the results.  The degree of pain experienced by patients is far less than the pain experienced by simple banding or excisional surgery.  Out of the 16 patients I have done so far there has been 1-2 who complained of pain lasting for a couple of days mainly because the haemorrhoids were too large and involving the anal skin causing the pain.  The feedback I have had by every patient has been so encouraging and supportive that this is one of the best techniques discovered and introduced so far.  I offer it to all my patients now with recurrent and with 2nd degree up to 4th degree haemorrhoids without a significant external component (external haemorrhoids are skin tags).  Hopefully within the coming few months I should have a significant number of cases which I can publish and confirm what a fantastic and desirable procedure this is for such a problem which affects almost 80% of people.  In the long-term once I have a good number of patients over the coming couple of years with long-term follow-up I shall be able to publish some more results.  I hope I continue to perform this fantastic procedure for the foreseeable future.  Please let me know if you require any information.”

Mr Gamal Barsoum MD, FRCS, MB BCh, MRCS, LRCPConsultant General & Colorectal Surgeon practicing at Spire Parkway Hospital (Private) and Birmingham Heartlands & Solihull NHS Trust. Honorary Senior Clinical Lecturer, Birmingham University

“I have found Rafaelo to be simple, effective and safe in the treatment of haemorrhoids. It is extremely well tolerated, and enables a rapid return to normal activities”

Mr Simon Middleton MB, ChB, MS, FRCS (Gen Surg)Consultant General & Colorectal Surgeon practicing privately at Spire Dunedin & The Whiteley Clinic and at The Royal Berkshire NHS Trust

“Through The Birmingham Haemorrhoid Clinic, I see a lot of patients with haemorrhoids, offering various treatments including banding, THD, haemorrhoidectomy, eXroid and Rafaelo.  Having been performing the Rafaelo procedure for a couple of years now, it has become my treatment of choice for patients with grade 2 and 3 haemorrhoids.  I perform the procedure under local anaesthetic, which is appealing to many patients, and the results I have observed have been extremely encouraging, with a very low complication profile to date.  At follow-up, the majority of patients report resolution of their symptoms and a very quick recovery from the procedure, and they would recommend it to others.  Rafaelo, in my opinion, certainly offers an excellent option to patients who desire a “minimally invasive treatment” for their haemorrhoids.”

Mr David McArthur MBChB, MRCS (Ed), MD, FRCSEd (Gen Surg)Consultant Colorectal & General Surgeon practicing at Spire Parkway Hospital

“The procedure is quick and easy to perform with effective results. The most important aspect is that patients are pain free and can walk out of hospital to return to work the next day. This is a huge advantage compared to other haemorrhoid treatments available. I now plan to use The Rafaelo Procedure as first line treatment for prolapsing symptomatic piles in the future”

Mr Amyn Haji MA MBBChir MSc MD FRCS Consultant Colorectal & Laparoscopic Surgeon, Clinical Lead for Endoscopy and Colorectal Surgery, Honorary Senior Lecturer King’s College Hospital, London.

“Having undertaken the first cohort of Rafaelo patients in the West Midlands, I am extremely excited over this revolutionary state of the art technology for the management of haemorrhoids.

‘Piles surgery’ has traditionally been a painful and highly morbid operation. Rafaelo has turned this on its head. The immediate advantage is the ability to avoid a general anaesthetic. This allows the patient to effectively walk in and walk out of the clinic following treatment. My own patients have had very little in the way of discomfort and initial follow up results are very pleasing both from a clinical response to treatment and from patient feedback.

I am receiving enquiries, almost on a daily basis now, for Rafaelo treatments and I am very confident that over time this will become a gold standard technique.”

Mr Patel’s private practice website can be found at www.mramitpatel.co.uk

Mr Amit Patel. MD FRCSMr Patel is a Consultant Laparoscopic General and Colorectal Surgeon. He is a Senior Academy Tutor at Worcestershire Acute NHS Trust and practices privately at Spire South Bank and BMI Droitwich Spa Hospitals.

“There are many ways to treat haemorrhoids and it is important to tailor the treatment to suit the patient. The Rafaelo procedure fills a much needed gap in the available treatments for haemorrhoids between banding and more invasive and painful procedures. The vast majority of the patients I have treated with Rafaelo have had excellent results. Less invasive, less painful and a quicker recovery.”

Mr Nicholas Stylianides MBChB FRCSConsultant Colorectal and General Surgeon at BMI The Alexandra and Manchester Royal Infirmary

“The Rafaelo procedure offers a much needed minimally invasive option in the treatment of haemorrhoidal disease, underpinned by clinical effectiveness, safety and high patient satisfaction.”

Mr Liviu Titu MD, FRCS (Gen Surg)Consultant General & Colorectal Surgeon practicing at Spire Murrayfield Hospital, Wirral

I have recommended the Rafaelo Procedure to many of my patients over the last 2 years. It is a effective and relatively painless way of dealing with troublesome piles.”

Mr Neil Kukreja MBBS, MSc, FRCS, Gen SurgConsultant General & Colorectal Surgeon practicing at Spire Alexandra Hospital

“I have found the Rafaelo procedure to be a quick, comfortable and efficacious treatment for suitable symptomatic haemorrhoids. Using this new application of well-established radiofrequency technology I have patients who have avoided conventional haemorrhoidectomy surgery. Patients are able to return to normal activities quickly with little or no disruption and minimal or no post-procedure discomfort. I am pleased to be able to add the Rafaelo procedure to the options I have to treat patients with troublesome haemorrhoids”.

Mr Nick West MBBS, MD(Res), FRCS (Gen)Consultant Colorectal & Laparoscopic Surgeon, Clinical Lead Department of Surgery, Epsom & St Helier University Hospitals NHS Trust & Consultant Surgeon Spire St Anthony’s Hospital, Surrey

“After a very useful period of training in Germany using the Rafaelo procedure and equipment, I felt confident to perform this in my own practice since as Colorectal Surgeons we are all aware of how painful a ‘classical haemorrhoidectomy’ can be for our patients, and Rafaelo provides a fantastic alternative. I have used this now for some of the more ‘challenging’ prolapsing huge piles in patients who have ‘failed’ other types of haemorrhoidal treatments, with excellent initial audited results and patient satisfaction scores overall at 9.5 to 10 out of a maximum 10, and so far no failures of Rafaelo nor dissatisfied patients.”

Mr Stephen Warren BSc Hons, MB BS, FRCS, FRCS(Gen Surg), MSMr Warren is a laparoscopic general and colorectal surgeon operating out of BMI Kings Oak and Cavell Hospitals, as well as the Wellington and Highgate Hospitals in London.

“I am currently recommending the Rafaelo technique to my patients with haemorrhoids because our experience with this technique so far has been very positive. Patients experience good results with excellent resolution of their symptoms and very little pain or discomfort. So far we have largely treated Grade II haemorrhoids but some with Grade III haemorrhoids have also experienced good results. The biggest advantage for this technique is the lack of post-operative pain. It has always struck me over the 30 years of experience in surgery that although haemorrhoids can be painful and distressing over many years they are not dangerous and the treatment should not be worse than the problem”

Mr Joseph Ellul MB, BCh., MCh (Wales)., FRCSMr Ellul is a Consultant Colorectal and Laparoscopic Surgeon at BMI Chelsfield Hospital in Orpington, Kent and BMI The Sloane Hospital in Beckenham, Kent.

“I have found the Rafaelo procedure to be a safe and effective alternative surgical treatment for Haemorrhoids using well established radio frequency technology. The majority of my patients undergoing this procedure have experienced minimal post-operative pain, if any at all, and have returned to normal activities much sooner than those who have undergone traditional surgery for haemorrhoids. I will be offering the Rafaelo Procedure as first line treatment to patients requiring surgical intervention for symptomatic haemorrhoids”

Mr Hitesh Patel MB ChB MS(Lon) FRCS(Eng) FRCS(Gen Surg)Consultant Colorectal Surgeon

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Rafaelo for Surgeons – your questions answered.

Why should I offer The Rafaelo Procedure?

Whilst most surgeons have their preferred treatment for the removal of haemorrhoids, generally depending upon the grade, no-one professes to have found one treatment which is entirely satisfactory above all others. All traditional treatments incur some element of inter-procedural or post-procedural pain for the patient and generally the recurrence rates have been shown to hover around the 30% mark across the board. In many cases, traditional treatments require the costly use of theatre space, with some procedures taking up to an hour to complete, and most requiring post-operative after-care to aid patient recovery.

The Rafaelo Procedure can take a fraction of the time to perform, is relatively painless for the patient with them often requiring no more than mild sedation and local anaesthetic.

Rafaelo is generally offered as a day-case procedure in Endoscopy (relieving the burden on theatres) and in most cases the patient leaves shortly after treatment with no pain whatsoever.  Multiple patients report returning to a normal, haemorrhoid free lifestyle the same day. For more information on the Procedure itself, go to The Rafaelo Procedure page.

We receive thousands of hits on our website each month from people seeking haemorrhoid treatment and many who enquire are referred by us to their nearest practitioner – this provides any surgeon with a boost to their existing private practice.

Finance is available – please call for details or email us at info@rafaelo.co.uk

What training is required?

The Rafaelo Procedure is quick and simple to operate.  Training is provided free of charge to surgeons interested in learning more about the procedure and in becoming an Approved Rafaelo Procedure Practitioner themselves.

We are working with a growing number of surgeons throughout the UK, more than 80 of whom have already been trained and are planning to offer the treatment from their respective hospitals. The treatment is already being offered from several BMI, Spire, Nuffield, Private Independent Hospitals and Clinics, as well as now being offered at selected NHS hospitals.  Feedback has been extremely positive from both surgeons and patients alike.

Training is held regularly but spaces are strictly limited and all sessions are usually over-subscribed, so early registration is advised (please click the button below to register your interest) Generally, there is a 2 month waiting list to become enrolled onto a training session.

Who is suitable for The Rafaelo Procedure?

Any adult suffering from haemorrhoidal symptoms and/or who present with internal piles can be considered for the treatment.

The procedure is prohibited for patients with the following indications: Pregnancy, Heart Disease (incl. pacemaker), Cutaneous Infection, Anal Fissures or infective anal pathologies like Cryptitis or Proctitis. The manufacturer also advises against its use on patients with existing staples from previous treatment.

Extreme caution should be taken with patients on anti-coagulants or anti-platelet medication, or with any medical condition which might affect their healing process. If they wish to proceed with this procedure, the patient should be warned accordingly and give consent regarding their heightened risk of bleeding during and post procedure. Instructions must be given to withdraw from such medication at least 7 days prior & 14 days post treatment.

All other aspects of operating the device, contraindications not mentioned here and post-operative complications will be provided at the initial training and presented in the IFU.

Is The Rafaelo Procedure recognised by Private Health Insurers?

The Rafaelo Procedure is covered by AVIVA, CIGNA and WPA and we expect other main insurers to follow suit in coming months.

NICE Guidance and existing clinical research

NICE published their Guidance on the use of radio frequency ablation in the treatment of haemorrhoids in August 2017, with recommendations. At that time, limited UK clinical studies were available and hence their advice was for surgeons performing the procedure to audit their results in order for long term data to be collated. NICE provided a data collection form to facilitate this process.

Click here to download – NICE clinical-audit-tool.

We have also provided a number of documents to ensure that patients are properly advised as to the risks of the procedure, namely:


Rafaelo Information for patients

Click on either of the above links to download.

More recently, a number of studies continue to be carried out both in the UK and across Europe, the latest one to have been published was in the Journal of Coloproctology – June 2018.

Others studies are currently being compiled in the UK and indeed two have been approved for publication, links to which will appear here shortly.

We are in the process of creating a multi-user cloud/app based data audit facility, in conjunction with University College Hospital, London, via secure password access, to allow all approved Rafaelo practitioners to contribute their treatment data for further collective analysis and study.

How will The Rafaelo Procedure be marketed?

We currently work with the Business Development Managers, Executive Directors and marketing departments of each hospital to support the Surgeon in the introduction of the Rafaelo system.  We will continue to offer support in supervising initial cases and promoting the treatment locally. We also assist in the presentation of the treatment to local MACs and in new novel procedure applications, when required.

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