Effect of a mixture of diosmin, coumarin glycosides, and triterpenes on bleeding, thrombosis, and pain after stapled anopexy: a prospective, randomized, placebo-controlled clinical trial.
OBJECTIVE
We evaluated the efficacy of oral administration of a mixture of diosmin, coumarin glycosides, and Centella asiatica (Venoplant®) in preventing bleeding, pain, and thrombosis of internal and external hemorrhoids after stapled anopexy (SA).


METHODS
SA was conducted in 182 patients with third-degree hemorrhoids. Preoperatively, patients were randomized evenly into two groups. Group A patients were administered Venoplant for 30 days post-SA, and group B received a placebo for 30 days post-SA. Patients received paracetamol for postoperative pain. Visit (v)1, v2, and v3 took place 7, 15, and 30 days postoperatively, respectively; bleeding (clinical examination), visual analog scale (VAS), thrombosis (clinical examination), and pain (paracetamol dosage, VAS) were evaluated.


RESULTS
At v1, v2, and v3, the numbers of patients with bleeding in groups A and B were 21 and 46, 3 and 25, and 1 and 5, respectively (p < 0.05). At v1, v2, and v3, the numbers of patients in groups A and B with thrombosed internal hemorrhoids were 3 and 13, 2 and 11, and 1 and 8, respectively (p < 0.05). The number of patients who took at least one paracetamol tablet was similar in both groups at v1 but was significantly greater in group B than group A at v2 and v3 (p < 0.05); pain VAS scores were equivalent at v1 and significantly greater in group B than group A at v2 and v3 (p < 0.05).


CONCLUSIONS
Venoplant effectively reduced bleeding after SA, decreased the incidence of thrombosed internal hemorrhoids, and decreased postoperative pain.
Department of General Surgery and Colorectal Surgery, S. Maria dei Battuti Hospital, Via Brigata Bisagno, 4, 31015, Conegliano, Veneto (TV), Italy. mschianodivisconte@gmail.com.
Michele
M
Schiano di Visconte
Department of General Surgery, S. Valentino Hospital, Via Montegrappa, 32, , 31044, Montebelluna, TV, Italy.
Francesco
F
Nicolì
Department of General Surgery and Colorectal Surgery, S. Maria dei Battuti Hospital, Via Brigata Bisagno, 4, 31015, Conegliano, Veneto (TV), Italy.
Roberto
R
Del Giudice
Department of General Surgery and Colorectal Surgery, S. Maria dei Battuti Hospital, Via Brigata Bisagno, 4, 31015, Conegliano, Veneto (TV), Italy.
Tommaso
T
Cipolat Mis
D000082:Acetaminophen / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D003374:Coumarins / Q000627:therapeutic use*; D003710:Demography; D013505:Digestive System Surgical Procedures; D004145:Diosmin / Q000627:therapeutic use*; D005260:Female; D006027:Glycosides / Q000627:therapeutic use; D006484:Hemorrhoids / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D010919:Placebos; D011446:Prospective Studies; D017792:Surgical Stapling; D013927:Thrombosis / Q000188:drug therapy*; D014315:Triterpenes / Q000627:therapeutic use*
D003374:Coumarins; D006027:Glycosides; D010919:Placebos; D014315:Triterpenes; D000082:Acetaminophen; D004145:Diosmin; C030123:coumarin
Bleeding; Complications; Pain; Stapled anopexy; Thrombosis; Venoplant