Do dietary spices impair the patient-reported outcomes for stapled hemorrhoidopexy? A randomized controlled study

Postoperative pain is a concern for patients seeking hemorrhoid surgery. Stapled hemorrhoidopexy is popular due to better patient-reported outcomes (PROs). Pain is the index of PROs. Posthemorrhoidectomy patients usually opt for a spice-free diet due to fear of pain or anal pruritus induced by spices. Curcumin and peprin (spice constituents) have powerful antiinflammatory and antioxidant properties. Ability to resume a normal taste-habituated meal may improve PRO quality of life. Thus, spice-related paradoxic conservatism in stapled hemorrhoidopexy, which involves no open wound, needed to be studied. A prospective open-ended study (July 2008 to August 2009) investigated consecutive candidates for day-care stapled hemorrhoidopexy randomized by the date of birth method into a controlled group (receiving a spices-free diet) and a study group (receiving a spicy diet) after an ethics and informed consent protocol. A standard perioperative protocol was followed. At discharge, the patients were advised to resume a normal diet (spicy or bland) and instructed to maintain a pain diary (100-point visual analog scale [VAS]) and an analgesic diary. Paracetamol 650 mg was used for pain exceeding a VAS score of 25. Patients were followed on day 3 and weeks 1 and 3. Failure to be discharged from day care, failure to maintain patient diary, and squamous epithelium in the rectal donut were the withdrawal criteria. A total of 67 patients were randomized. The groups were well matched for demographics, comorbidities, types of anesthesia, hemorrhoidal grades, and withdrawal. Statistically significant improvement in PROs (P < 0.05) and a lower consumption of analgesic tablets were seen in the study group (spicy diet). No adverse event was reported in either group. Resumption of a spicy diet has no adverse impact on PROs after stapled hemorrhoidopexy. Reduced analgesic usage in the spicy diet study group needs to be evaluated further for any potential benefits of spices.