Hemorrhoids - Minimally invasive Operations
Surgery is indicated for grade 3 and 4 hemorrhoids or recurrent bleeding
Radiofrequency ablation (Rafaelo®)
Modern, low-pain surgery for hemorrhoidal disease under local anesthesia
| Facts about the Rafaelo procedure |
|
Outpatient surgery: Yes |
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General anesthesia: No |
| Operation time: 10 - 20 minutes |
| Open wounds: No |
| Incapacity for work: 1-5 days |
|
Cost: Covered by TK, several BKKs, and PKV in our clinic |
What is Rafaelo Therapy?
This is a new surgical treatment procedure that can be performed on an outpatient basis and, in contrast to other procedures, is very painless.
A major advantage over all other surgical procedures is the possibility of an operation without general anesthesia.
In most cases, the hemorrhoidal cushions of 2-3 degrees are cauterized with a heat probe (radiofrequency ablation) under local anaesthesia (the patient is awake). The dead tissue slowly dissolves and the reduced blood flow causes the hemorrhoidal tissue to shrink and scar after 4-6 weeks. During this “remodeling process”, patients have no or only very minor restrictions.
The procedure has been established in vein surgery for years and is an integral part of the low-pain treatment options. The outpatient procedure takes a maximum of 15 minutes and patients can go home after a short monitoring phase for post-operative bleeding.
Afterwards, there are no restrictions in everyday life and a sick note is usually only necessary for 1-3 days. Very rarely, painful swelling of the nodes may occur in the following days, which can be easily treated with anti-inflammatory medication.
The costs for this new procedure will be covered by the Techniker Krankenkasse (TK) and multiple BKK health insurance companies as well as most private health insurance companies. Other company health insurance funds are expected to follow.
Incidentally, the word Rafaelo® does not stand for a chocolate, but for “Radio Frequency Treatment of Haemorrhoids under Local Anaesthesia”.
The homogeneous treatment ensures:
- Tissue reduction in the hemorrhoidal node
- Closure of the arteries that supply the hemorrhoidal node
- Maximum preservation of muscle, anoderm and mucosa
- Restoration of the natural anatomy
- No foreign bodies, e.g. staples, need to be attached and - unlike other methods - there is no risk of stenosis with Rafaelo®.
- Healing is excellent as there are no incisions compared to conventional operations.
The procedure does not cause any wounds in the anal skin or inside the anal canal. As a result, the patient has less post-operative pain and can return to normal activities within a short time.
“We have been using the RAFAELO method regularly in large numbers since 2015 and have nationwide expertise”
What exactly happens during the Rafaelo treatment?
The operation is performed under local anesthesia. After inserting a proctoscope, the local anesthetic is injected painlessly between the hemorrhoidal node and the rectal wall.
This is followed by thermocoagulation with a heat probe for approx. 60-200 seconds per hemorrhoidal node with 1800-2500 joules. The hemorrhoid and hemostasis occur simultaneously.
Finally, the patient is cooled with compresses and the blood is checked for dryness. Patients can leave the practice on their own after a brief monitoring and check for post-operative bleeding.
Surgery cannot be performed on the following patients:
- Pregnancy
- Heart disease (including pacemakers)
- Skin infections in the anal area
- Anal fissures or infectious diseases such as cryptitis or proctitis
- Existing staples after Longo surgery or cancer surgery in the rectal area.
For a better understanding of the operation, there is an animated video on You Tube. It clearly shows you the course of the RAFAELO method.
For patients with a longer journey, we can offer a combined appointment over 2 days. On the first day, the patient is examined and, if necessary, informed about the operation. However, not all patients are suitable for this form of therapy! Please make an appointment at: op@copv.berlin
FAQ - Frequently asked questions about Rafaelo therapy
We can only determine this after an examination at our clinic. Based on our experience, we consider this method to be useful only for hemorrhoids up to grade 3. The consistency of the rectal mucosa (prolapse) and the sphincter pressure are also decisive factors. If the sphincter is too tense, surgery under local anesthesia cannot be performed.
We can only provide a reliable assessment of a treatment option using the RAFAELO method after an examination at our clinic. Therefore, a personal consultation is essential. Due to patient rights legislation, there must be at least 24 hours between the consultation and a planned operation, meaning that an operation cannot and must not take place on the day of the initial consultation.
For most patients, Rafaelotherapy causes only minor discomfort such as pressure and slight spotting during the first 7 days. Depending on the extent of the procedure, patients may be unable to work for 1-5 days. You can drive immediately after the operation and resume sports activities after 3 days. Weight training should only be resumed after 1 week.
Currently, only TK, mKK, and several company health insurance funds (BKK) cover the costs under “integrated care” contracts. Most private insurance companies also cover the costs. However, it is better to ask in advance.
It is best for the operation if you have a bowel movement before the procedure, but laxatives are not necessary. Constipation should be avoided. You may eat and drink before the procedure and wear dark underwear in case a few drops of blood are lost.
No, regular bowel movements are important. Please do not suppress them. Constipation should be avoided at all costs during the first 7 days. After Rafaelo therapy, you can continue to eat normally and do not need to take any special precautions.
NThe procedure and your visit to our practice will take approximately 30 minutes. The following day, we will perform a brief check-up to see if there has been any bleeding, swelling, or pain. A final check-up can be performed after 6 weeks.
A feeling of pressure and slight bleeding are common and can last up to 7 days. In rare cases, small blood clots may form in the anus (anal vein thrombosis), which are painful but harmless and disappear after a few days. Serious complications such as infections or inflammation have been reported, but we have not yet encountered any such cases. Incontinence is not affected, as the technique does not involve surgery on the sphincter muscle.
Hemorrhoids - Laser therapy
Safe laser treatment of hemorrhoids with the LHP method
| Facts about the LHP procedure |
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Outpatient surgery: Yes |
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General anesthesia: Yes |
| Operation time: 10 - 20 minutes |
| Open wounds: Yes, but small |
| Incapacity for work: 1-5 days |
|
Cost: Covered by TK, several BKKs, and PKV in our clinic |
Laser hemorrhoidoplasty (LHP). This procedure gives you the opportunity to treat second and third degree hemorrhoids much more gently compared to conventional surgical procedures. There is considerably less pain and the time off work is only a few days.
During laser treatment, energy is applied centrally to the respective hemorrhoidal node in a controlled manner. The sensitive anoderm and mucosa (mucosa) are preserved to a high degree.
The homogeneous laser radiation of the LHP® fiber, which is necessary for this procedure, ensures
- Tissue reduction in the hemorrhoidal node
- Closure of the arteries that supply the hemorrhoidal node
- Maximum preservation of muscle, anoderm and mucosa
- Restoration of the natural anatomy
Laser coagulation can be used to treat single or multiple hemorrhoidal nodes in one session. The controlled delivery of laser energy to the hemorrhoidal cushions causes the hemorrhoidal nodes to shrink.
In addition, the mucous membrane is repositioned in its original position in the rectum by strengthening the underlying connective tissue. This prevents the development or re-development of a prolapse, i.e. the hemorrhoidal tissue hanging out of the anus.
No foreign bodies, e.g. staples, need to be attached and - unlike other methods - there is no risk of stenosis with LHP®. Healing is excellent as there are no incisions and only very small stitches of 3 mm compared to conventional operations.
The hemorrhoid is reached through this small opening at the edge of the anus. This procedure does not cause any wounds in the anal skin or inside the anal canal. As a result, the patient has less post-operative pain and can return to normal activities within a short time.
- No large cuts
- No stitches
- Small open wounds, no oozing
- Minimal pain
- Short absence from work - ideal for the self-employed
What exactly happens during laser treatment?
1. the laser fiber is positioned
under vision exactly in the center of the
hemorrhoidal cushion
placed under vision.
2. the LHP® laser fiber is used to
each haemorrhoid from the inside
from the inside out using heat.
3. as a result of the treatment
the haemorrhoids reduce in size
and slowly recede over 4-6 weeks.
For a better understanding of the laser method, Biolitec has an animated video on You Tube. This clearly shows you the course of the operation using the LHP method.
FAQ - Frequently asked questions about LHP therapy
Laser hemorrhoidoplasty (LHP) is a minimally invasive procedure in which the enlarged hemorrhoidal vessels are closed from the inside using a fine laser beam (usually a 1470 nm diode laser). No tissue is cut out, but rather specifically destroyed by the laser energy—the tissue then shrinks.
The method is generally suitable for grade II–III hemorrhoids, i.e., when symptoms such as bleeding, oozing, or protrusion are present, but there is no severe prolapse with irreparable nodes. In cases of grade IV a decision is made on an individual basis as to whether another therapy is more appropriate.
Significantly less pain after the procedure. No open wounds, therefore faster healing. Short procedure (approx. 15–30 minutes, usually outpatient). Low risk of bleeding. Quick return to everyday life (often after a few days).
The procedure is usually performed on an outpatient basis or in a day clinic under local or general anesthesia. A fine laser probe is used to direct energy directly into the hemorrhoidal cushions. The tissue contracts, leaving the mucous membrane largely intact. After a short observation period, the patient can usually go home on the same day.
TUsually only minor pain (often treatable with paracetamol or ibuprofen). Return to work after 2–5 days. Complete healing after approx. 2–3 weeks. Showering is permitted immediately. Normal bowel regulation (fiber, sufficient fluids) supports healing.
As with any procedure, the following may occur in rare cases: Slight bleeding or discharge. Temporary foreign body sensation. Very rare recurrence (renewed swelling due to poor bowel habits or straining). Serious complications (e.g., infection, incontinence) are extremely rare and, according to studies, occur in less than 1% of cases.
Long-term data and large studies (e.g., Weyand et al. 2019, Wee et al. 2023) show: When indicated correctly, the results are permanently stable, with high patient satisfaction and a low relapse rate. Bowel regulation and follow-up care are crucial to prevent relapses.
Currently, only TK, mKK, and several company health insurance funds (BKK) cover the costs under “integrated care” contracts. Most private insurance companies also cover the costs. However, it is better to ask in advance..
You are welcome to book an appointment with our doctors.
We look forward to hearing from you.