Background: This study was designed to assess the outcome of using a new technique of mucosal ablation using a radiofrequency device followed by its plication for rectal mucosal prolapse and to compare its results with the conventional ligature and excision procedure.

Materials and Methods: The procedure of radiofrequency ablation and mucosal plication (RAMP) is described. A Ellman radiofrequency generator was used for the procedure. Out of the 46 patients with rectal mucosal prolapse, 24 patients were randomized to undergo ligature and excision procedure (LEP) and 22 were operated with RAMP. The operating time, amount of pain (VAS scale), postoperative analgesic requirement, time to return to work, wound healing period and postoperative complications were documented.

Results: Radiofrequency ablation and mucosal plication procedure on average resulted in short operation time (9 vs. 32 minutes, p<0.05), shorter hospitalization (16 vs.42 hours, p< 0.05) significantly less postoperative pain, fewer cumulative requests for analgesia by the patients (21 vs.54 tablets, p< 0.05), earlier return to work (7 vs. 18 days, p<0.05) and faster wound healing (14 vs. 35 days, p< 0.05)

The complication rate was 9 % with RAMP group and 29 % with LEP group.

Conclusion: The procedure of radiofrequency ablation and plication of mucosa shows promising results in patients with rectal mucosal prolapse. Being safe, effective, and a swift technique, it can be proposed as an improved alternative to conventional surgical procedure. 

Keywords: Rectal mucosal prolapse, plication, radiofrequency ablation, ligature and excision, pain.

1. Goligher J, Duthie H, Nixon H. Prolapse of the rectum. In Surgery of the anus rectum and colon. 5th edition Bailliere Tindall, London, 1992. Pp 246-284.
2. Tsiaoussis J, Chrysos E, Glynos M, Vassilakis JS, Xynos E. Pathophysiology and treatment of anterior rectal mucosal prolapse syndrome. Br J Surg 1998; 85:1699-1702.
3. Pietroletti R, Nemati Fard M, Vasapollo L, Pescatori M. Manual vs. stapled excision of rectal mucosal prolapse: clinical and functional results.
   Ann Ital Chir. 2004; 75:331-335.
4. Araki Y, Ishibashi N, Kishimoto Y, Matono K, Nakagawa M, Nozoe Y, Sasatomi T, Ogata Y, Shirouzu K. Circular stapling procedure for mucosal prolapse of the rectum associated with outlet obstr-uction. Kurume Med J 2001; 48:201-204.
5. Milito G, Gargiani M, Cortese F. Randomised trial comparing LigaSure haemorrhoidectomy with diathermy dissection operation. Tech Coloproctol 2002; 6: 171-175.
6. Pernice LM, Bartalucci B, Bencini L, Borri A, Catarzi S, Kroning K. Early and late (ten years) experience with circular stapler hemorrhoidectomy Dis Colon Rectum 2001; 44: 836-841.
7. Seow-Choen F. Stapled haemorrhoi-dectomy: pain or gain. Br J Surg 2001; 88:1-3.
8. Gupta PJ. Radiofrequency ablation and plication of hemorrhoids. Tech Coloproctol.2003; 7: 45-50.
9. Gupta PJ. Plication of hemorrhoids after radiofrequency ablation: An alternative to Hemorrhoidectomy. Annals of Saudi Medicine 2002; 22: 267-268.
10. Gupta PJ. Novel technique: radiofrequency coagulation--a treatment alternative for early-stage hemorrhoids. Med Gen Med. 2002; 4: 1.
11. Rex J, Ribera M, Bielsa I, Paradelo C, Ferrandiz C. Surgical management of rhinophyma: report of eight patients treated with electrosection. Dermatol Surg 2002; 28: 347-349.
12. Pfenninger JL, DeWitt DE. Radio frequency surgery. In: Pfenninger JL, Fowler GC.edts. Procedures for primary care physicians. 1994; St.Louis: Mosby. 91-101.
13. Saidi MH, Setzler FD Jr., Saddler RK, Farhart SA, Akright BD. Comparison of office loop electro surgical conization and cold knife conization. J Am Assoc Gynecol laparosc.1994; 1: 135-139.
14. Farag A.E. Pile suture: A new technique for the treatment of Hemorrhoids. Br.J.Surg 1978; 65: 293-295.
15. Awojobi OA. Modified pile suture in the outpatient treatment of hemorrhoids. A preliminary report. Dis Colon Rectum 1983; 26: 95-97.
16. Shafik A. Mucosal plication in the treatment of partial rectal prolapse. Pediatr Surg Int. 1997; 12:386-388.
17. El-Sibai O, Shafik AA. Cauterization-plication operation in the treatment of complete rectal prolapse. Tech Coloproctol 2002; 6:51-54.
18. Gaj F, Trecca A, Garbarino M, Flati G. Transfixed stitches for the treatment of hemorrhoids. Chir Ital. 2004; 56:699-703.
19. Marquez A, Siverio J, Acosta J, Marquez A, Acosta B. Ligation and sclerosis technique combined with electrocoa-gulation resection of internal hemorrhoids G-E-N. 1991; 45: 114-118.
20. Hussein AM. Ligation-anopexy for treatment of advanced hemorrhoidal disease. Dis Colon Rectum. 2001; 44:1887-1890.
21. Appel RH. Plication of rectal mucosa. J Indiana State Med Assoc 1978; 71: 684-685.
22. Yamana T.Iwadare J. Mucosal plication (Gant-Miwa procedure) with anal encircling for rectal prolapse- a review of the Japanese experience. Dis Colon Rectum. 2003; 46:S94-99.
23. Oyake D, Ochi K, Takatsu M, Shintani T, Umehara T, Koizuka I. Clinical effect of bipolar radiofrequency thermotherapy on allergic rhinitis. Nippon Jibiinkoka Gakkai Kaiho. 2004; 107: 695-701.
24. Oshima F, Yamakado K, Akeboshi M, Takaki H, Nakatsuka A, Makita M, Takeda K. Lung radiofrequency ablation with and without bronchial occlusion: experimental study in porcine lungs. J Vasc Interv Radiol. 2004; 15:1451-1456.
25. Fillingeri V, Gravante G, Baldessari E, Grimaldi M, Casciani CU. Prospective randomized trial of submucosal hemorrhoidectomy with radiofrequency bistoury vs. conventional Parks’ operation. Tech Coloproctol 2004; 8:31-36.
26. Friedman M, Mikityansky I, Kam A, Libutti SK, Walther MM, Neeman Z, Locklin JK, Wood BJ. Radiofrequency ablation of cancer. Cardiovasc Intervent Radiol. 2004; 27:427-434.
27. Haines D. Biophysics of ablation: application to technology. J Cardiovasc Electrophysiol. 2004; 15:S2-S11.
28. Gupta PJ. A comparative study between radiofrequency ablation with plication of hemorrhoids and Milligan-Morgan h-emorrhoidectomy for grade 3 hemorrhoids. Tech Coloproctol 2004; 8:163-168.
29. Pescatori M, Quondamcarlo C. A new grading of rectal internal mucosal prolapse and its correlation with diagnosis and treatment. Int J Colorectal Dis. 1999; 14: 245-249.
30. Altomare DF, Rinaldi M, Chiumarulo C. Palasciano N. Treatment of external anorectal mucosal prolapse with circular stapler: an easy and effective new surgical technique. Dis Colon Rectum. 1999; 42:1102-1105.
31. Boccasanta P.Capretti PG, Venturi M, Cioffi U, De Simone M, Salamina G, Contessini-Avesani E, Peracchia A. Randomised controlled trial between stapled circumferential mucosectomy and conventional circular hemorrhoidectomy in advanced hemorrhoids with external mucosal prolapse. Am J Surg. 2001; 182:64-68.

Dr Smita Uday Vaidya

Address: Procto Clinic Sai Suman Hospital, Plot No. 10, Vasant Vihar,

Behind Awanti Nagar, Near Old Pune Naka, Solpaur - 413001 Maharashtra