THE EFFECTS OF GINGER FOR PREVENTION POST-OPERATIVE ILEUS AFTER HYSTERECTOMY: A RANDOMIZED CONTROLLED TRIAL.

Problem: Postoperative ileus following hysterectomy has been observed in rate of 10-30%. Previous studies have indicated that ginger may alleviate the severity of abdominal distension and enhance the ability to eat in patients after cesarean section.

Objective: This study aims to investigate the effects of ginger as an adjunct to the Enhanced Recovery After Surgery (ERAS) pathway after hysterectomy.

Methods: This study was conducted as a randomized controlled trial with investigator blinding. Patients who underwent hysterectomy without requiring nothing-by-mouth (NPO) status were enrolled and allocated to study arms using a block of four randomization numbers. The control arm adhered to the ERAS pathway, while the study arm received ginger supplementation of 1 g starting 3 hours after the operation and 1 g after each meal, totaling 9 doses. Postoperative outcomes, including bowel functions, eating tolerability, wound complications, and side effects, were recorded. Data were analyzed using PASW Statistics, version 18 (SPSS Inc., Chicago, IL, USA). A p-value of <0.05 was considered statistical significance.

Results: A total of 160 patients, with 80 patients allocated to each arm. The median age was 47 years old (interquartile range [IQR] 44.0-51.0), and the median BMI was 24.2 mg/m² (IQR 21.5-27.9). The median operative time was 130 minutes (IQR 105-165). The incidence of postoperative epigastric pain was 51 (31.9%), while bloating was observed in 71 patients (44.4%). Within 12 hours post-operation, flatus was reported in 41 patients (25.6%), and 46 patients (28.8%) experienced ileus. Laxative agents were required by 39 patients (24.4%). There were no significant differences in the time to first flatus (17.3±8.1 vs. 17.1±7.9 hours, p=0.869), time to tolerate a soft diet (11.7±6.1 vs. 11.2±6.6 hours, p=0.660), time to tolerate a regular diet (22.9±7.3 vs. 21.9±5.3 hours, p=0.324), or length of hospitalization (57.3±18.1 vs. 53.6±16.6 hours, p=0.180) between study arms. Additionally, a higher number of patients in the ginger group tolerated a regular diet compared to the control group (75.0% vs. 65.0%, p=0.168). No side effects related to ginger or febrile morbidity were observed.

Conclusion(s): Ginger did not significantly decrease the incidence of post-hysterectomy ileus or enhanced the recovery of bowel function.