title: How we can improve patients' comfort after Milligan-Morgan open haemorrhoidectomy.
abstract: OBJECTIVE
  To demonstrate the value of Diosmin (flavonidic fraction) in the management of post-haemorhoidectomic symptoms.
  
  
  METHODS
  Eighty-six consecutive patients with grades III and IV acute mixed hemorrhoids admitted to the Anorectal Surgical Department of First Affiliated Hospital, Xinjiang Medical University from April 2009 to April 2010, were enrolled in this study. An observer-blinded, randomized trial was conducted to compare post-haemorhoidectomic symptoms with use of Diosmin flavonidic fraction vs placebo. Eighty-six patients were randomly allocated to receive Diosmin flavonidic fraction 500 mg for 1 wk (n = 43) or placebo (n = 43). The Milligan-Morgan open haemorrhoidectomy was performed by a standardized diathermy excision method. Pain, bleeding, heaviness, pruritus, wound edema and mucosal discharge were observed after surgery. The postoperative symptoms and hospitalization time were recorded.
  
  
  RESULTS
  The mean age of the Diosmin group and controls was 53.2 and 51.3 years, respectively. In Diosmin group, haemorrhoid piles were of the third degree in 33 patients and the fourth degree in 10; and in the control group, 29 were of the third degree and 14 were of the fourth degree. There was no statistically significance in age, gender distribution, degree and number of excised haemorrhoid piles, and the mean duration of haemorrhoidal disease between the two groups. There was a statistically significant improvement in pain, heaviness, bleeding, pruritus from baseline to the 8th week after operation (P < 0.05). Patients taking Diosmin had a shorter hospitalization stay after surgery (P < 0.05). There was also a significant improvement on the proctoscopic appearance (P < 0.001). However, there was no statistical difference between the two groups in terms of wound mucosal discharge. Two patients experienced minor bleeding at the 8th week in Diosmin group, and underwent surgery.
  
  
  CONCLUSIONS
  Diosmin is effective in alleviating postoperational symptoms of haemorrhoids. Therefore, it should be considered for the initial treatment after haemorrhoid surgery. However, further prospective randomized trials are needed to confirm the findings of this study.
authors.affiliation: Department of Anorectal Surgical, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, Xinjiang Uygur Autonomous Region, China. mamutjan206@sina.com
authors.forename: Ma-Mu-Ti-Jiang A
authors.initials: MM
authors.lastname: Ba-bai-ke-re
authors.forename: Hong-Guo
authors.initials: HG
authors.lastname: Huang
authors.forename: Wen-Ni
authors.initials: WN
authors.lastname: Re
authors.forename: Kai
authors.initials: K
authors.lastname: Fan
authors.forename: Hui
authors.initials: H
authors.lastname: Chu
authors.forename: Er-Ha-Ti
authors.initials: EH
authors.lastname: Ai
authors.forename: Mai-Mai-Ti-Tu-Er-Xun Ke
authors.initials: MM
authors.lastname: Li-Mu
authors.forename: Yi-Rui
authors.initials: YR
authors.lastname: Wang
authors.forename: Hao
authors.initials: H
authors.lastname: Wen
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D002681:China; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D004145:Diosmin / Q000627:therapeutic use*; D004487:Edema / Q000209:etiology / Q000517:prevention & control; D004564:Electrocoagulation / Q000009:adverse effects; D005260:Female; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control; D011351:Proctoscopy; D011446:Prospective Studies; D011537:Pruritus / Q000209:etiology / Q000517:prevention & control; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects
chemical_list: D004145:Diosmin