Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Longo A. 1998 Treatment of haemorrhoidal disease by reduction of mucosa and haemorrhoidal prolapse with a circular stapling device: a new procedure. Proceedings of the 6th World Congress of Endoscopic Surgery Rome 3–6, pp. 777–784

  2. Porrett LJ, Porrett JK, Ho YH (2015) Documented complications of stapled hemorrhoidopexy: a systematic review. Int Surg 100:44–57

    Article  PubMed  PubMed Central  Google Scholar 

  3. Ortiz H, Marzo J, Armendáriz P, De Miguel M (2005) Stapled hemorrhoidopexy vs. diathermy excision for fourth-degree hemorrhoids: a randomized, clinical trial and review of the literature. Dis Colon Rectum 48:809–815

    Article  PubMed  Google Scholar 

  4. Sobrado CW, Cotti GC, Coelho FF, Rocha JR (2006) Initial experience with stapled hemorrhoidopexy for treatment of hemorrhoids. Arch Gastroenterol 43:238–242

    Google Scholar 

  5. Perera N, Liolitsa D, Iype S, Croxford A, Yassin M, Lang P, Ukaegbu O, van Issum C (2012) Phlebotonics for haemorrhoids. Cochrane Database Syst Rev 8:CD004322

    Google Scholar 

  6. Altomare DF, Roveran A, Pecorella G, Gaj F, Stortini E (2006) The treatment of hemorrhoids: guidelines of the Italian Society of Colorectal Surgery. Tech Coloproctol 10:181–186

    Article  CAS  PubMed  Google Scholar 

  7. Ho YH, Foo CL, Seow-Choen F, Goh HS (1995) Prospective randomized controlled trial of a micronized flavonodic fraction to reduce bleeding after hemorrhoidectomy. Bri J Surg 82:1034–1035

    Article  CAS  Google Scholar 

  8. La Torre F, Nicolai AP (2004) Clinical use of micronized purified flavonoid fraction for treatment of symptoms after hemorrhoidectomy: results of a randomized, controlled, clinical, trial. Dis Colon Rectum 47:704–710

    Article  CAS  PubMed  Google Scholar 

  9. Ebbinghaus SW, Mahler JL, Marshall ME 1997. Novel coumarin activity on albino rats and shows anti-coagulant and anti-oxidant activity. Wiley; 45:195–209

  10. Gohil KJ, Patel JA, Anuradha K, Gajjar AK (2010) Pharmacological review on Centella asiatica: a potential herbal cure-all. Indian J Pharm Sci 72:546–556

    Article  PubMed  PubMed Central  Google Scholar 

  11. Forte R, Cennamo G, Bonavolontà P, Pascotto A, de Crecchio G, Cennamo G (2013) Long-term follow-up of oral administration of flavonoids, Centella asiatica and Melilotus, for diabetic cystoid macular edema without macular thickening. J Ocul Pharmacol Ther 29:733–737

    Article  CAS  PubMed  Google Scholar 

  12. Goligher JC, Lealock AG, Brossy JJ (1955) Surgical anatomy of the anal canal. Br J Surg 43:51

    Article  CAS  PubMed  Google Scholar 

  13. Lohsiriwat V (2012) Hemorrhoids: from basic pathophysiology to clinical management. World J Gastroenterol 18:2009–2017

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Aigner F, Gruber H, Conrad F et al (2009) Revised morphology and hemodynamics of the anorectal vascular plexus: impact on the course of hemorrhoidal disease. Int J Color Dis 24:105–113

    Article  Google Scholar 

  15. Cospite M (1994) Double-blind, placebo-controlled evaluation of clinical activity and safety of MPFF in the treatment of acute haemorrhoids. Angiology 445:566–573

    Google Scholar 

  16. Incandela L, Cesarone MR, Cacchio M et al (2001) Total triterpenic fraction of Centella asiatica in chronic venous insufficiency and in high-perfusion microangiopathy. Angiology 52(Suppl 2):S9–13

    PubMed  Google Scholar 

  17. Lyseng-Williamson KA, Perry CM (2003) Micronised purified flavonoid fraction: a review of its use in chronic venous insufficiency, venous ulcers and haemorrhoids. Drugs 63:71–100

    Article  CAS  PubMed  Google Scholar 

  18. Pleşca-Manea L, Pârvu AE, Pârvu M, Taămaş M, Buia R, Puia M (2002) Effects of Melilotus officinalis on acute inflammation. Phytother Res 16:316–319

    Article  PubMed  Google Scholar 

  19. Lessiani G, Iodice P, Nicolucci E, Gentili M (2015) Lymphatic edema of the lower limbs after orthopedic surgery: results of a randomized, open-label clinical trial with a new extended-release preparation. J Biol Regul Homeost Agents 29:805–812

    CAS  PubMed  Google Scholar 

  20. Matsuda H, Morikawa T, Ueda H, Yoshikawa M (2001) Medicinal foodstuffs. XXVII. Saponin constituents Gotu Kola (2): structures of new ursane- and oleanane-type triterpene oligoglycosides, centellasaponin B, C, and D, from Centella asiatica cultivated in Sri Lanka. Chem Pharm Bull 49:1368–1371

    Article  CAS  PubMed  Google Scholar 

  21. Inamdar PK, Yeole RD, Ghogare AB, de Souza NJ (1996) Determination of biologically active constituents in Centella asiatica. J Chromatogr A 742:127–130

    Article  CAS  Google Scholar 

  22. Bonfill M, Mangas S, Cusidó RM, Osuna L, Piñol MT, Palazón J (2006) Identification of triterpenoid compounds of Centella asiatica by thin-layer chromatography and mass spectrometry. Biom Chromatogr 20:151–153

    Article  CAS  Google Scholar 

  23. Yao CH, Yeh JY, Chen YS, Li MH, Huang CH (2015) Wound-healing effect of electrospun gelatin nanofibres containing Centella asiatica extract in a rat model. J Tissue Eng Regen Med. doi:10.1002/term.1992

    Google Scholar 

  24. Cesarone MR, Laurora G, De Sanctis MT, Belcaro G (1992) Activity of Centella asiatica in venous insufficiency. Minerva Cardioangiol 40:137–143

    CAS  PubMed  Google Scholar 

  25. Tenni R, Zanaboni G, De Agostini MP (1988) Effect of the triterpenoid fraction of Centella asiatica on macromolecules of the connective matrix in human skin fibroblast cultures. Ital J Biochem 37:69–77

    CAS  PubMed  Google Scholar 

  26. Arpaia MR, Ferrone R, Amitrano M (1990) Effects of Centella asiatica extract on mucopolysaccharide metabolism in subjects with varicose veins. Int J Clin Pharmacol Res 10(4):229–233

    CAS  PubMed  Google Scholar 

  27. Mlakar B, Kosorok P (2005) Flavonoids to reduce bleeding and pain after stapled hemorrhoidopexy: a randomized controlled trial. Wien Klin Wochenschr 117:558–560

    Article  CAS  PubMed  Google Scholar 

  28. Casley-Smith JR, Foldi-Borksok E, Foldi M (1974) Fine structural aspects of lymphoedema in various tissues and the effects of treatment with coumarin and troxerutin. Br J Exp Pathol 55:88–93

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Casley-Smith JR, Földi-Börcsök E, Földi M (1975) A fine structural demonstration that some benzopyrones act as vitamin P in the rat. Am J Clin Nutr 28:1242–1254

    CAS  PubMed  Google Scholar 

  30. Bubols GB, Vianna Dda R, Medina-Remon A et al (2013) The antioxidant activity of coumarins and flavonoids. Mini Rev Med Chem 13:318–334

    CAS  PubMed  Google Scholar 

  31. Gravié JF, Lehur PA, Huten N et al (2005) Stapled hemorrhoidopexy versus Milligan–Morgan hemorrhoidectomy: a prospective, randomized, multicenter trial with 2-year postoperative follow up. Ann Surg 242:29–35

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

We thank Mr. Simone Teso, MD (University of Padua, Italy), for performing the statistical analyses.

Author information

Authors and Affiliations

  1. Department of General Surgery and Colorectal Surgery, S. Maria dei Battuti Hospital, Via Brigata Bisagno, 4, 31015, Conegliano, Veneto (TV), Italy

    Michele Schiano di Visconte, Roberto Del Giudice & Tommaso Cipolat Mis

  2. Department of General Surgery, S. Valentino Hospital, Via Montegrappa, 32, , 31044, Montebelluna, TV, Italy

    Francesco Nicolì

Authors
  1. Michele Schiano di Visconte
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francesco Nicolì
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Roberto Del Giudice
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tommaso Cipolat Mis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michele Schiano di Visconte.

Ethics declarations

Conflict of interest

Aesculapius Pharmaceuticals (Brescia, Italy) provided Venoplant, the placebo, and paracetamol tablets. The authors enrolled patients independently and did not provide access to data or results to staff from Aesculapius Pharmaceuticals. Statistical analyses were undertaken in a blinded fashion by an independent statistician who communicated the results to the authors only at the end of the study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Electronic supplementary material

ESM 1

(XLS 90 kb).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schiano di Visconte, M., Nicolì, F., Del Giudice, R. et al. 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. Int J Colorectal Dis 32, 425–431 (2017). https://doi.org/10.1007/s00384-016-2698-z

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-016-2698-z

Keywords

Search

Navigation