Evaluation of the Value of Perianal Infiltration During Thermodestruction of Haemorrhoidal Disease by Radiofrequency

NCT ID: NCT05519189

Last Updated: 2025-12-22

Basic Information

• Recruitment Status: ACTIVE_NOT_RECRUITING
• Clinical Phase: PHASE4
• Total Enrollment: 134 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2023-01-10
• Study Completion Date: 2026-02-28

Brief Summary

Haemorrhoidal disease is a common and benign condition (1). Anatomically, there is an external and internal component. Only internal haemorrhoidal disease is managed by radiofrequency. Different levels of severity of internal haemorrhoidal disease have been defined by the Goligher classification (1). According to the recommendations for clinical practice established by the French National Society of ColoProctology (SNFCP), grade I and II haemorrhoidal disease should be managed instrumentally after failure of medical treatment. Grade III and IV haemorrhoidal disease is an indication for surgical management in the first instance or after failure of instrumental treatments. The standard technique is the Milligan and Morgan procedure (pedicle haemorrhoidectomy) described in 1937 (2). This technique consists of the removal of the 3 internal haemorrhoidal bundles. It remains the most effective but is responsible for postoperative complications, in particular pain, haemorrhage, anal strictures and anal incontinence (3), (4). Less aggressive techniques have been developed (Longo technique, HAL-RAR technique). The Longo technique is a circular stapling haemorrhoidopexy. The haemorrhoidal packets are brought up into the anal canal with the help of a circular aggravating forceps removing a collar of rectal mucosa. This removal of the mucosa also allows the vascularisation of the haemorrhoidal venous network to be interrupted. The HAL- RAR technique is a non-resection technique consisting of arterial ligation of the haemorrhoidal packets in order to interrupt the vascularisation supplying the haemorrhoidal packets. This technique can be performed with or without Doppler guidance. Recently, Renshaw et al. described a technique for coagulation of haemorrhoidal bundles using a radiofrequency probe (5).

This technique has shown satisfactory results and is an interesting option in the management of haemorrhoidal disease (6) with low postoperative pain (7).

In order to limit patients' postoperative pain and reduce their apprehension during defecation episodes, a perianal block has been shown to reduce postoperative pain in patients with a haemorrhoidectomy technique (8,9). In 2019, a prospective randomised trial (10) confirmed the value of this perianal block without a neurostimulator during a haemorrhoidal pack resection procedure. A perianal infiltration of 40 ml of 0.5% Ropivacaine was performed. These 40ml were divided into 4 injections of 10ml each in the left and right antero-lateral position and in the left and right postero-lateral position in relation to the anal margin.

The hemorrhoidal pack resection technique is known to induce postoperative pain. Haemorrhoidal radiofrequency (RAFAELO® procedure) is a new minimally invasive technique that reduces postoperative pain and is usually performed on an outpatient basis (6). Currently, peri-anal infiltration is routinely performed for all haemorrhoidal surgery whether or not there is a haemorrhoidal resection. No studies have evaluated the relevance of maintaining peri-anal infiltration in non-resected haemorrhoidal surgery and in particular during radiofrequency haemorrhoidal packets. In addition, ropivacaine infiltration is not without risks. Local anaesthesia has potential risks for the patient:

• Adverse reaction or hypersensitivity to local anaesthetics and components
• Infection at the injection site or infiltration
• Haematoma at the injection or infiltration site The aim of our study is to demonstrate the non-inferiority of discontinuing perianal infiltration in patients with thermodestructive haemorrhoidal surgery.

Conditions

Hemorrhoids

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: SUPPORTIVE_CARE
• Blinding Strategy: SINGLE

Study Groups

Peri-anal infiltration of Ropivacaine

Group Type: ACTIVE_COMPARATOR

Ropivacaine

Intervention Type: DRUG

Peri-anal infiltration of Ropivacaine

Failure to perform peri-anal ropivacaine infiltration

Group Type: EXPERIMENTAL

Failure to perform peri-anal ropivacaine infiltration

Intervention Type: OTHER

Failure to perform peri-anal ropivacaine infiltration

Interventions

Ropivacaine

Peri-anal infiltration of Ropivacaine

Intervention Type: DRUG

Failure to perform peri-anal ropivacaine infiltration

Failure to perform peri-anal ropivacaine infiltration

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Major patient
• Patient scheduled to undergo hemorrhoidal thermodestruction surgery (RAFAELO® procedure)
• Patient able to understand the protocol and having given written informed consent to participate in the study
• Patient affiliated to the social security system or entitled to it

Exclusion Criteria

• Patient < 18 years old
• Patient with previous hemorrhoidectomy surgery (LONGO technique)
• Patient with previous pexy ligation surgery (HAL-RAR technique)
• Patients with known hypersensitivity to local anaesthetics or components
• Patient with a long term (>1 month) analgesic treatment (level II and III)
• Patient participating in another interventional clinical research protocol involving a drug or clinical investigation of a medical device
• Patient who is pregnant, breastfeeding or able to procreate without contraception
• Patient under guardianship, curatorship or deprived of liberty

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Centre Hospitalier Departemental Vendee

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Emeric ABET

Role: PRINCIPAL_INVESTIGATOR

Centre Hospitalier Départemental Vendée

Farouk DRISSI

Role: PRINCIPAL_INVESTIGATOR

Nantes University Hospital

Yann REDON

Role: PRINCIPAL_INVESTIGATOR

Clinique Mutualiste de l'Estuaire

Locations

Centre Hospitalier Départemental Vendée

La Roche-sur-Yon, , France

Centre Hospitalier Universitaire de Nantes

Nantes, , France

Clinique Mutualiste de l'Estuaire

Saint-Nazaire, , France

Countries

France

Other Identifiers

CHD21_0121

Identifier Type: -

Identifier Source: org_study_id