Do Dietary Spices Impair the Patient Reported Outcomes in Stapled Hemorrhoidopexy ? a Randomized Controlled Study

Objectives of Study
Postoperative pain is a deterrent for patients seeking hemorrhoid surgery. Stapled hemorrhoidopexy an effective, safe, day care procedure has become popular due to better short term patient reported outcomes (PRO), the index being pain. Post Hemorrhoidectomy patients are usually advised a bland (spice free) diet lest the spices caused evacuatory / post-evacuatory pain /peri-anal burning / itching presumably by irritating the open wound. Curcumin and Peprin (the constituents of spices like turmeric, chilli and pepper) have been reported to have powerful anti-inflammatory/ anti-oxidant/ pro-healing properties even at nano-molar levels. Ability to resume normal taste habituated meal is a patient reported indicator of quality of life. Thus the spice related paradoxical conservatism needs to be studied in stapled hemorrhoidopexy where there is no open wound. We studied the effect of dietary spices on PROs of stapled hemorrhoidopexy.

Methods and procedures
Prospective (July 2008 to August 2009) open ended study on well evaluated consecutive candidates for stapled hemorrhoidopexy randomized by date of birth (DOB) method into controlled group (bland spices free diet) and study group (normal diet with full spices), following ethics and informed consent protocol. Standard pre-operative evaluation for day care surgery, rectal preparation, per-operative anesthesia, antibiotic & analgesia protocol was followed. At discharge all patients were advised immediate resumption of normal diet (spice or bland accordingly) with the instruction to maintain diary for pain (100 point visual analog scale-VAS) and analgesic usage (number of analgesic tablets used). Paracetamol 650 mg was prescribed to be used if pain >25 VAS. Patients were followed clinically on 3rd day (D3), 1st week (W1) and 3rd week (W3) for the appropriate PRO based end points as shown in table. Any adverse event precluding discharge from day care , failure to maintain patient diary & presence of squamous epithelium on histopathology of the rectal donut were the withdrawal criteria.

A total of 67 patients were randomized. The groups were well matched for demographics, co-morbidities, type of anesthesia and hemorrhoidal grades. There were 19 withdrawals all because of non maintenance of patient diaries. There was statistically significant improvement in PROs & lower consumption of analgesic tablets in the study group. No adverse events, postoperative bleeding, fever or sepsis was reported in either of the groups.

Group Total Withdrawal Studied Pain,peri-anal burning/irritation AnalgesicTablets used in 3 Weeks
D3 W1 W3 Mean Range
Study 32 7 25 20 2 0 7 5-31
Control 35 12 23 16 5 0 11 10-27

Resumption of normal spicy diet has no adverse impact on patient reported outcomes in stapled hemorrhoidopexy. Its apparent benefits in the present study and its impact on patient reported quality of life need to be studied in larger studies.

Session: Podium Presentation

Program Number: S091

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