The impact of ginger on preventing postoperative ileus after hysterectomy under the enhanced recovery after surgery protocol: A randomized controlled trial

Main Article Content

Preeyanuntar Pongsupanimit
Reawika Chaikomin
Pinpat Tripatara
Vuthinun Achariyapota
Boonlert Viriyapak
Sudarat Kanpetpanao
Natchanon Sathapanapitagkit
IRENE RUENGKHACHORN

Abstract

Objective: To investigate the impact of ginger supplementation on postoperative ileus following hysterectomy under the enhanced recovery after surgery protocol.


Methods: A randomized controlled trial with investigator blinding was conducted. The control arm followed the enhanced recovery after surgery (ERAS) pathway exclusively, while the intervention arm received ginger supplementation. The outcomes assessed postoperatively were bowel function, tolerability of oral intake, wound complications, and adverse effects of treatment.


Results: One hundred sixty patients participated, with 80 allocated to each arm. The median duration of the operative procedure was 130 minutes (Interquartile range [IRQ], 105 to 165). Within the first 12 hours postoperatively, 41 patients (25.6%) reported the passage of flatus, and 46 patients (28.8%) experienced ileus. All patients resuming a solid diet within 24 hours. When comparing the control arm to the ginger arm, no significant differences emerged with respect to the postoperative ileus time interval (14.7 ± 7.8 vs 13.6 ± 8.4 hours, p = 0.432), time until the first passage of flatus (17.3 ± 8.1 vs 17.1 ± 7.9 hours, p = 0.869), time to start a solid diet (11.7 ± 6.1 vs 11.2 ± 6.6 hours,  p = 0.660), and time to well tolerate a solid diet (18.6 [IQR 14.6 to 20.9] vs 17.3 [IQR 6.2 to 20.1] hours, p = 0.596). The length of the hospital stay did not differ significantly. No adverse effects related to ginger or instances of febrile morbidity were observed.


Conclusions: Ginger supplementation did not significantly reduce the incidence of postoperative ileus or the recovery of bowel function following hysterectomy under the enhanced recovery after surgery protocol.

Article Details

How to Cite
(1)
Pongsupanimit , P.; Chaikomin, R.; Tripatara , P.; Achariyapota, V.; Viriyapak, B.; Kanpetpanao, S.; Sathapanapitagkit , N.; RUENGKHACHORN, I. The Impact of Ginger on Preventing Postoperative Ileus After Hysterectomy under the Enhanced Recovery After Surgery Protocol: A Randomized Controlled Trial. Thai J Obstet Gynaecol 2024.
Section
Original Article

References

Fanning J, Hojat R. Safety and efficacy of immediate postoperative feeding and bowel stimulation to prevent ileus after major gynecologic surgical procedures. J Am Osteopath Assoc 2011;111:469-72.

Nelson G, Bakkum-Gamez J, Kalogera E, Glaser G, Altman A, Meyer LA, et al. Guidelines for perioperative care in gynecologic/oncology: Enhanced Recovery After Surgery (ERAS) Society recommendations-2019 update. Int J Gynecol Cancer 2019;29:651-68.

Venara A, Neunlist M, Slim K, Barbieux J, Colas PA, Hamy A, et al. Postoperative ileus: Pathophysiology, incidence, and prevention. J Visc Surg 2016;153:439-46.

Li ZL, Zhao BC, Deng WT, Zhuang PP, Liu WF, Li C, et al. Incidence and risk factors of postoperative ileus after hysterectomy for benign indications. Int J Colorectal Dis 2020;35:2105-12.

Luckey A, Livingston E, Tache Y. Mechanisms and treatment of postoperative ileus. Arch Surg 2003;138:206-14.

MacMillan SL, Kammerer-Doak D, Rogers RG, Parker KM. Early feeding and the incidence of gastrointestinal symptoms after major gynecologic surgery. Obstet Gynecol 2000;96:604-8.

Boitano TKL, Smith HJ, Rushton T, Johnston MC, Lawson P, Leath CA, 3rd, et al. Impact of enhanced recovery after surgery (ERAS) protocol on gastrointestinal function in gynecologic oncology patients undergoing laparotomy. Gynecol Oncol 2018;151:282-6.

de Groot JJ, Ament SM, Maessen JM, Dejong CH, Kleijnen JM, Slangen BF. Enhanced recovery pathways in abdominal gynecologic surgery: a systematic review and meta-analysis. Acta Obstet Gynecol Scand 2016;95:382-95.

Gomez-Hidalgo NR, Pletnev A, Razumova Z, Bizzarri N, Selcuk I, Theofanakis C, et al. European Enhanced Recovery After Surgery (ERAS) gynecologic oncology survey: Status of ERAS protocol implementation across Europe. Int J Gynaecol Obstet 2023;160:306-12.

Schilder JM, Hurteau JA, Look KY, Moore DH, Raff G, Stehman FB, et al. A prospective controlled trial of early postoperative oral intake following major abdominal gynecologic surgery. Gynecol Oncol 1997;67:235-40.

Eamudomkarn N, Kietpeerakool C, Kaewrudee S, Jampathong N, Ngamjarus C, Lumbiganon P. Effect of postoperative coffee consumption on gastrointestinal function after abdominal surgery: A systematic review and meta-analysis of randomized controlled trials. Sci Rep 2018;8:17349.

Kadirogullari P, Seckin KD, Yalcin Bahat P, Aytufan Z. The effect of chewing gum on bowel function postoperatively in patients with total laparoscopic hysterectomy: a randomised controlled trial. J Obstet Gynaecol 2022;42:1192-7.

Jirawongprapa Y, Chotboon C, Songthamwat S, Summart U, Songthamwat M. Effects of caffeine dose on bowel function recovery following gynecologic cancer surgery: A randomized double-blind controlled trial. Thai J Obstet Gynaecol 2023;31:265-72.

Sillapasa C, Jeerasap R, Tangsiriwatthana T. Metoclopramide for preventing ileus after benign gynecologic surgery: A randomized controlled trial. Thai J Obstet Gynaecol 2023;31:192-200.

Chaiyakunapruk N, Kitikannakorn N, Nathisuwan S, Leeprakobboon K, Leelasettagool C. The efficacy of ginger for the prevention of postoperative nausea and vomiting: a meta-analysis. Am J Obstet Gynecol 2006;194:95-9.

Tianthong W, Phupong V. A randomized, double-blind, placebo-controlled trial on the efficacy of ginger in the prevention of abdominal distention in post cesarean section patients. Sci Rep 2018;8:6835.

Apariman S, Ratchanon S, Wiriyasirivej B. Effectiveness of ginger for prevention of nausea and vomiting after gynecological laparoscopy. J Med Assoc Thai 2006;89:2003-9.

Vather R, Bissett I. Management of prolonged post-operative ileus: evidence-based recommendations. ANZ J Surg 2013;83:319-24.

Wongpia I, Thinkhamrop J, Seejorn K, Buppasiri P, Luanratanakorn S, Temtanakitpaisan T, et al. Incidence of and risk factors for febrile morbidity after laparoscopic-assisted vaginal hysterectomy. Int J Womens Health 2014;6:385-8.

Mazzotta E, Villalobos-Hernandez EC, Fiorda-Diaz J, Harzman A, Christofi FL. Postoperative Ileus and Postoperative Gastrointestinal Tract Dysfunction: Pathogenic Mechanisms and Novel Treatment Strategies Beyond Colorectal Enhanced Recovery After Surgery Protocols. Front Pharmacol 2020;11:583422.

Jernigan AM, Chen CC, Sewell C. A randomized trial of chewing gum to prevent postoperative ileus after laparotomy for benign gynecologic surgery. Int J Gynaecol Obstet 2014;127:279-82.

Pearl ML, Valea FA, Fischer M, Mahler L, Chalas E. A randomized controlled trial of early postoperative feeding in gynecologic oncology patients undergoing intra-abdominal surgery. Obstet Gynecol 1998;92:94-7.

Gungorduk K, Ozdemir IA, Gungorduk O, Gulseren V, Gokcu M, Sanci M. Effects of coffee consumption on gut recovery after surgery of gynecological cancer patients: a randomized controlled trial. Am J Obstet Gynecol 2017;216:145 e1- e7.

Hansen CT, Sorensen M, Moller C, Ottesen B, Kehlet H. Effect of laxatives on gastrointestinal functional recovery in fast-track hysterectomy: a double-blind, placebo-controlled randomized study. Am J Obstet Gynecol 2007;196:311 e1-7.

Kraus K, Fanning J. Prospective trial of early feeding and bowel stimulation after radical hysterectomy. Am J Obstet Gynecol 2000;182:996-8.

Fanning J, Yu-Brekke S. Prospective trial of aggressive postoperative bowel stimulation following radical hysterectomy. Gynecol Oncol 1999;73:412-4.

Zick SM, Djuric Z, Ruffin MT, Litzinger AJ, Normolle DP, Alrawi S, et al. Pharmacokinetics of 6-gingerol, 8-gingerol, 10-gingerol, and 6-shogaol and conjugate metabolites in healthy human subjects. Cancer Epidemiol Biomarkers Prev 2008;17:1930-6.

Nikkhah Bodagh M, Maleki I, Hekmatdoost A. Ginger in gastrointestinal disorders: A systematic review of clinical trials. Food Sci Nutr 2019;7:96-108.