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Kaveh M, Yeganehzad S, Rabie Ashkezary M, Hesarinejad MA, Todaro A, Nishinari K. Chewing gum base: A comprehensive review of composition, production, and assessment methods: Advances and approaches in biodegradability. J Texture Stud 2023; 54:789-807. [PMID: 37584385 DOI: 10.1111/jtxs.12793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/05/2023] [Accepted: 07/25/2023] [Indexed: 08/17/2023]
Abstract
The gum base mass is a colloidal system and the main component of chewing gum; which is an inert, non-nutritious, indigestible, and insoluble part of chewing gum, therefore this substance does not dissolve in the mouth when chewed. The gum base plays the most crucial role in determining the mechanical properties, flexibility, and overall quality of chewing gum. Moreover, it acts as a delivery system to transport sweeteners, flavorings, and other ingredients in chewing gum. Despite the massive market for chewing gum and the provision of a list of the main ingredients in gum base by the Code of Federal Regulations and some international organizations, there is a lack of information about chewing gum base and its compositions in the literature. Therefore, the purpose of this review is to present an overview of the characteristics, ingredients and applications, production process, assessment, and modification methods of the gum base along with the advances and approaches in biodegradability. Biodegradability concerns play a promoting role in the research and development of chewing gum and its applications in the food industry, medical and dental sectors. Reviewing previous studies can surely help for faster development of this path.
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Affiliation(s)
- Mona Kaveh
- Department of Food Processing, Research Institute of Food Science and Technology (RIFST), Mashhad, Iran
| | - Samira Yeganehzad
- Department of Food Processing, Research Institute of Food Science and Technology (RIFST), Mashhad, Iran
| | - Mansour Rabie Ashkezary
- Department of Agriculture, Food and Forest Sciences, Università degli Studi di Palermo, Palermo, Italy
| | - Mohammad Ali Hesarinejad
- Department of Food Processing, Research Institute of Food Science and Technology (RIFST), Mashhad, Iran
| | - Aldo Todaro
- Department of Agriculture, Food and Forest Sciences, Università degli Studi di Palermo, Palermo, Italy
| | - Katsuyoshi Nishinari
- Glyn O. Phillips Hydrocolloid Research Centre, School of Food and Biological Engineering, Hubei University of Technology, Wuhan, China
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Douligeris A, Diakosavvas M, Kathopoulis N, Kypriotis K, Mortaki A, Angelou K, Chatzipapas I, Protopapas A. The Effect of Postoperative Gum Chewing on Gastrointestinal Function Following Laparoscopic Gynecological Surgery. A Meta-analysis of Randomized Controlled Trials. J Minim Invasive Gynecol 2023; 30:783-796. [PMID: 37422054 DOI: 10.1016/j.jmig.2023.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE To assess the effect of postoperative gum chewing on gastrointestinal function in women following laparoscopic gynecological surgery for benign indications. DATA SOURCES We screened 5 major databases (Medline, Scopus, Google Scholar, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov) from inception till February 2023. METHODS OF STUDY SELECTION No language restrictions were applied. We included randomized controlled trials comparing the postoperative bowel function between patients who chewed and patients who did not chew gum postoperatively after laparoscopic gynecological procedures for benign indications. TABULATION, INTEGRATION, AND RESULTS Data from 5 studies on 670 patients were extracted and analyzed by 3 independent reviewers. Meta-analysis was performed with RevMan 5.4 software (Copenhagen: The Nordic Cochrane Center, The Cochrane Collaboration, 2020), with mean differences (MDs), pooled risk ratios, and random-effects model. Postoperative gum chewing significantly reduced the time to first bowel sounds and the time to first passage of flatus (MD -2.58 hours 95% confidence interval (CI) -4.12 to -1.04 p = .001 and MD -3.97 hours 95% CI -6.26 to -1.68 p <.001, respectively). The time to first defecation, the time to first postoperative patients' mobilization, the length of hospital stay, and the risk of postoperative bowel obstruction showed no statistically significant difference between the 2 groups. When subgroup analysis was performed according to the type of the laparoscopic procedure, it failed to reveal a positive impact of postoperative gum chewing in both the times to first passage of flatus and first defecation following laparoscopic hysterectomies (MD -5.35 hours 95% CI -10.93 to 0.23 p = .06 and MD -15.93 hours 95% CI -40.13 to 8.28 p = .20, respectively). CONCLUSION The results of the present meta-analysis support that postoperative gum chewing following laparoscopic gynecological procedures seems to have a positive effect on the early mobilization of the gastrointestinal tract. However, these results should be interpreted with caution due to the small number of the included randomized controlled clinical trials.
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Affiliation(s)
- Athanasios Douligeris
- Endoscopic Surgery Unit, 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - Michail Diakosavvas
- Endoscopic Surgery Unit, 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kathopoulis
- Endoscopic Surgery Unit, 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantinos Kypriotis
- Endoscopic Surgery Unit, 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Mortaki
- Endoscopic Surgery Unit, 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Kyveli Angelou
- Endoscopic Surgery Unit, 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Chatzipapas
- Endoscopic Surgery Unit, 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Protopapas
- Endoscopic Surgery Unit, 1st Department of Obstetrics & Gynecology, "Alexandra" Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Naz R, Özyazıcıoğlu N, Kaya M. Effects of menthol gum chewing on postoperative nausea, vomiting, and length of hospital stay in children undergoing appendectomy: A randomized controlled trıal. J Pediatr Nurs 2023; 72:92-98. [PMID: 37331121 DOI: 10.1016/j.pedn.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 06/05/2023] [Accepted: 06/05/2023] [Indexed: 06/20/2023]
Abstract
PURPOSE This study aimed to determine the effects of menthol gum chewing on nausea, vomiting, and length of hospital stay after appendectomy in children. BACKGROUND Postoperative nausea and vomiting (PONV) can be induced by general anesthesia. Several drugs are available to reduce the risk of PONV; however, their cost and side effects limit their clinical use. METHOD This was a randomized controlled clinical trial that included 60 children aged 7-18 years who underwent an appendectomy at the Pediatric Surgery Clinic of a tertiary hospital between April and June 2022. Data for this study were collected via the developed information form, which included participants' descriptive characteristics and bowel function parameters, and the Baxter Retching Faces (BARF) nausea scale. Children in the study group who underwent an appendectomy were given chewing gum and asked to chew it for an average of 15 min, whereas those in the control group received no intervention. RESULTS The BARF nausea score measured during the menthol gum chewing period was lower in the study group, and the difference score value calculated after pretest time was higher in the study group, as expected (p < 0.001). Moreover, menthol gum chewing was found to shorten hospital stay by 1 day (p < 0.05). CONCLUSION Menthol gum chewing reduced the severity of postoperative nausea and length of hospital stay. PRACTICE IMPLICATION Chewing gum can be used as a nonpharmacological method by pediatric nurses in clinical practice to reduce the severity of postoperative nausea and length of hospital stay.
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Affiliation(s)
- Rüya Naz
- University of Health Sciences, Bursa Yüksek Ihtisas Research and Training Hospital, Bursa, Turkey.
| | - Nurcan Özyazıcıoğlu
- Bursa Uludağ University, Faculty of Health Sciences, Department of Pediatric Nursing, Bursa, Turkey.
| | - Mete Kaya
- University of Health Sciences, Bursa Yüksek Ihtisas Research and Training Hospital, Clinic of Pediatric Surgery, Bursa, Turkey.
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Yin YN, Xie H, Ren JH, Jiang NJ, Dai L. The impact of gum-chewing on postoperative ileus following gynecological cancer surgery: A systematic review and meta-analysis of randomized controlled trials. Front Oncol 2023; 12:1059924. [PMID: 36733360 PMCID: PMC9887172 DOI: 10.3389/fonc.2022.1059924] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 12/28/2022] [Indexed: 01/18/2023] Open
Abstract
Objective To assess the effect and safety of gum-chewing on the prevention of postoperative ileus after gynecological cancer surgery. Methods We conducted a systematic review of randomized controlled trials (RCTs) published between 2000 and 2022 in English and Chinese, using the EBSCO, Web of Science, Scopus, Cochrane Central Register of Controlled Trials (Cochrane database), PubMed, Medline (via Ovid), Chinese National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database, and Wan Fang databases. A total of 837 studies were screened using Endnote software, and those that met the inclusion criteria were selected for analysis. The main outcome of interest was the incidence of postoperative ileus, and secondary outcomes included time to first flatus, time to first bowel movement, and length of hospital stay. Results Two authors extracted data and performed quality assessment independently. The review included six RCTs with a total of 669 patients. Compared with routine care, gum-chewing could significantly reduce the incidence of postoperative ileus (RR 0.46, 95% CI: 0.30, 0.72, P=0.0006), shorten the time to first flatus (WMD -9.58, 95% CI: -15.04, -4.12, P=0.0006), first bowel movement (WMD -11.31, 95% CI: -21.05, -1.56, P=0.02), and the length of hospital stay (WMD -1.53, 95% CI: -2.08, -0.98, P<0.00001). Conclusions Gum-chewing is associated with early recovery of gastrointestinal function after gynecological cancer surgery and may be an effective and harmless intervention to prevent postoperative ileus. Systemaic review registration https://www.crd.york.ac.uk/prospero/#searchadvanced, identifier CRD42022384346.
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Affiliation(s)
- Ya-Nan Yin
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China,West China School of Nursing, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Hong Xie
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China,West China School of Nursing, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Jian-Hua Ren
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China,West China School of Nursing, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Ni-Jie Jiang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China,West China School of Nursing, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China
| | - Li Dai
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, Sichuan University, Chengdu, China,National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, Sichuan, China,*Correspondence: Li Dai,
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Muhumuza J, Molen SF, Mauricio W, La O JS, Atumanyire J, Godefroy NB, Waziri MA, Kithinji SM, Sonye KM, Leocadie MM, Sikakulya FK, Kagenderezo BP, Lionel MS, Farah M, Lule H. Effect of Chewing Gum on Duration of Postoperative Ileus Following Laparotomy for Gastroduodenal Perforations: Protocol for a Randomized Controlled Trial. Int J Surg Protoc 2023; 27:9-17. [PMID: 36818423 PMCID: PMC9912851 DOI: 10.29337/ijsp.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/09/2023] [Indexed: 02/10/2023] Open
Abstract
Background Prolonged post-operative ileus is associated with increased risk of other complications, length of hospital stays and health care related costs. Chewing gum has been shown to reduce duration of ileus in many elective surgeries, but there is a paucity of randomised controlled trials (RCTs) on its effect on duration of ileus among patients undergoing emergency surgery, specifically patients with peritonitis. The aim of this study is to determine the effect of chewing gum on duration of postoperative ileus following laparotomy for gastroduodenal perforations. Methods This will be a randomised controlled trial done in 3 hospitals. Fifty-two patients will be randomised to 2 groups. Group A will receive chewing gum in addition to routine care, whereas group B will receive routine care only. The duration of post-operative ileus in the two groups which is the primary outcome, will be compared using the independent samples t-test in SPSS version 22. The length of hospital stay, in-hospital morbidity and mortality will be the secondary outcomes. This trial has been approved by Kampala International University research and Ethics committee (Ref No. KIU-2021-60) and Uganda national council of science and technology (Ref No. HS1665ES). Retrospective registration with the research registry has also been done (UIN: researchregistry8565). Highlights Prolonged post-operative ileus significantly contributes to adverse surgical outcomesChewing gum has been shown to reduce duration of ileus in many elective surgeriesThere is paucity of RCTs on role of chewing gum following surgery for peritonitis.
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Affiliation(s)
- Joshua Muhumuza
- Faculty of clinical medicine and dentistry, Department of Surgery, Kampala international University Western campus, Ishaka Bushenyi, Uganda
| | - Selamo Fabrice Molen
- Faculty of clinical medicine and dentistry, Department of Surgery, Kampala international University Western campus, Ishaka Bushenyi, Uganda
| | - William Mauricio
- Faculty of clinical medicine and dentistry, Department of Surgery, Kampala international University Western campus, Ishaka Bushenyi, Uganda
| | - Jorge Soria La O
- Faculty of clinical medicine and dentistry, Department of Surgery, Kampala international University Western campus, Ishaka Bushenyi, Uganda
| | - Jethro Atumanyire
- Faculty of Medicine and dentistry, Kampala international University Western campus, Ishaka Bushenyi, Uganda
| | - Nyenke Bassara Godefroy
- Faculty of clinical medicine and dentistry, Department of Surgery, Kampala international University Western campus, Ishaka Bushenyi, Uganda
| | - Musa Abbas Waziri
- Faculty of clinical medicine and dentistry, Department of Surgery, Kampala international University Western campus, Ishaka Bushenyi, Uganda,State Specialist Hospital (HMB), Department of Surgery. Maiduguri, Borno State Nigeria
| | - Stephen Mbae Kithinji
- Faculty of clinical medicine and dentistry, Department of Surgery, Kampala international University Western campus, Ishaka Bushenyi, Uganda
| | - Kiyaka Magugu Sonye
- Faculty of clinical medicine and dentistry, Department of Surgery, Kampala international University Western campus, Ishaka Bushenyi, Uganda
| | - Mugisho Munyerenkana Leocadie
- Faculty of clinical medicine and dentistry, Department of Surgery, Kampala international University Western campus, Ishaka Bushenyi, Uganda
| | - Franck Katembo Sikakulya
- Faculty of clinical medicine and dentistry, Department of Surgery, Kampala international University Western campus, Ishaka Bushenyi, Uganda,Faculté de médecine, Université Catholique du Graben, Butembo, RDC
| | - ByaMungu Pahari Kagenderezo
- Faculty of clinical medicine and dentistry, Department of Surgery, Kampala international University Western campus, Ishaka Bushenyi, Uganda
| | - Musafiri Simba Lionel
- Faculty of clinical medicine and dentistry, Department of Surgery, Kampala international University Western campus, Ishaka Bushenyi, Uganda
| | - Mumin Farah
- Faculty of clinical medicine and dentistry, Department of Surgery, Kampala international University Western campus, Ishaka Bushenyi, Uganda
| | - Herman Lule
- Faculty of clinical medicine and dentistry, Department of Surgery, Kampala international University Western campus, Ishaka Bushenyi, Uganda,Department of Clinical Medicine, Division of Clinical Neurosciences, University of Turku, FI-20014, Turku, Finland
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6
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Bang YJ, Lee JH, Kim CS, Lee YY, Min JJ. Anxiolytic effects of chewing gum during preoperative fasting and patient-centered outcome in female patients undergoing elective gynecologic surgery: randomized controlled study. Sci Rep 2022; 12:4165. [PMID: 35264684 PMCID: PMC8907183 DOI: 10.1038/s41598-022-07942-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 01/06/2022] [Indexed: 11/09/2022] Open
Abstract
Although previous studies reported that chewing gum during the preoperative fasting has the benefits of alleviating anxiety and dry mouth, preoperative chewing gum has yet to be accepted as a standard practice due to conventional anesthetic custom. Our study aimed to prospectively evaluate the effects of gum chewing on preoperative anxiety and patient's discomfort in female patients undergoing gynecologic surgery. Ninety-four patients were enrolled and randomized either into conventional fasting group (control group) or chewing gum with fasting group (gum group). The control group was instructed to fast from 3 p.m. on the day before surgery. The gum group performed preoperative fasting in the same manner, but was encouraged to chew gum freely during the fasting period. The primary endpoint was the degree of preoperative anxiety. For the evaluation of preoperative anxiety, Amsterdam preoperative anxiety and information scale (APAIS) was used. Preoperative gastric fluid volume and acidity were also measured as the secondary outcomes. Preoperative anxiety using APAIS was significantly lower in the gum group compared to the control group (control group vs. gum group: 20.9 vs. 17.8, p = 0.009). However, there was no significant difference in the gastric fluid analysis between the groups. In the female patients for elective gynecologic surgery, chewing gum during the preoperative fasting period helped to alleviate preoperative anxiety without additional increase of pulmonary aspiration risks.Trial registration: KCT0004422 (05/11/2019, https://cris.nih.go.kr ; registration number).
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Affiliation(s)
- Yu Jeong Bang
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Jong-Hwan Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Chung Su Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea
| | - Yoo-Young Lee
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong-Jin Min
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Korea.
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Zorrilla-Vaca A, Lasala JD, Mena GE. Updates in Enhanced Recovery Pathways for Gynecologic Surgery. Anesthesiol Clin 2022; 40:157-174. [PMID: 35236578 DOI: 10.1016/j.anclin.2021.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Gynecologic surgery encompasses over a quarter of inpatient surgical procedures for US women, and current projections estimate an increase of the US female population by nearly 50% in 2050. Over the last decade, US hospitals have embraced enhanced recovery pathways in many specialties. They have increasingly been used in multiple institutions worldwide, becoming the standard of care for patient optimization. According to the last updated enhanced recovery after surgery (ERAS) guideline published in 2019, there are several new considerations behind each practice in ERAS protocols. This article discusses the most updated evidence regarding ERAS programs for gynecologic surgery.
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Affiliation(s)
- Andres Zorrilla-Vaca
- Department of Anesthesiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Javier D Lasala
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 409 13th floor, Houston, TX 77030, USA
| | - Gabriel E Mena
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 409 13th floor, Houston, TX 77030, USA.
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8
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Kusika NP, Hutagaol IEB, Yusuf M, Suyanto S, Tilusari SP. The Role of Chewing Gum on Post-operative Bowel Recovery after Gynecological Laparoscopic Surgery: A Short Report and Updated Review. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Adverse post-operative complication of gynecological laparoscopic surgery, post-operative ileus, could be reduced by mimicking early post-operative oral feeding; however, the role of chewing gum is still lack evidence.
AIM: This study was conducted to assess chewing gum’s role in post-operative bowel recovery after gynecological laparoscopic surgery.
METHODS: This prospective clinical trial recruited 60 participants who had undergone gynecological laparoscopic surgery under general anesthesia. The study was conducted at Arifin Achmad Hospital, Riau Province, Indonesia, from January to April 2021. The patients were equally divided into two groups: Intervention (n = 30) and control (n = 30). They were asked to chew sugar-free gum every 2 h after the surgery (i.e. 5 times within 10 h post-surgery). Time of the first flatus and the first bowel sounds were recorded (i.e. 5 times of assessment within 10 h post-surgery). In addition, a literature review was conducted to add evidence of the role of chewing gum on postoperative bowel recovery after gynecological laparoscopic surgery.
RESULTS: Patients from both groups had a close age range (23–44-year-old versus 21–42-year-old). Our data suggested a significant difference in the time of the first flatus between the treatment and control group (15.95 h vs. 45.05 h), p < 0.001. The length of stay in the hospital among those from the treatment group was also significantly shorter compared to controls (15.50 h vs. 45.50 h), p < 0.001. The literature review of four updated randomized clinical trials suggests chewing gum in the early onset of first flatus and bowel movement.
CONCLUSION: Chewing gum following gynecological laparoscopic surgery could accelerate gastrointestinal recovery.
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Gungorduk K, Ozdemir IA. Non-pharmacological interventions for the prevention of postoperative ileus after gynecologic cancer surgery. Taiwan J Obstet Gynecol 2021; 60:9-12. [PMID: 33495015 DOI: 10.1016/j.tjog.2020.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 12/18/2022] Open
Abstract
Postoperative ileus (POI) is characterized by impaired gastrointestinal motility after surgery. POI is a major concern for surgeons because it increases hospital stay, the cost of care, and postoperative morbidity in patients who have undergone extensive gynecological oncological surgery. Although several interventions have been proposed and investigated, no effective treatment for the prevention and management of POI has been established. The present review summarizes the current evidence on non-pharmacological interventions, including coffee consumption and chewing gum, used to prevent and treat POI. We obtained studies from MEDLINE, Cochrane Database of Systematic Reviews, ISI Web of Science, and SCOPUS databases.
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Affiliation(s)
- Kemal Gungorduk
- Department of Gynecology and Oncology, Muğla Sitki Koçman University Education and Research Hospital, Muğla, Turkey.
| | - Isa Aykut Ozdemir
- Department of Gynecology and Oncology, Bakirkoy Sadi Konuk Research and Training Hospital, Istanbul, Turkey
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Elvir-Lazo OL, White PF, Yumul R, Cruz Eng H. Management strategies for the treatment and prevention of postoperative/postdischarge nausea and vomiting: an updated review. F1000Res 2020; 9. [PMID: 32913634 PMCID: PMC7429924 DOI: 10.12688/f1000research.21832.1] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 01/10/2023] Open
Abstract
Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) remain common and distressing complications following surgery. The routine use of opioid analgesics for perioperative pain management is a major contributing factor to both PONV and PDNV after surgery. PONV and PDNV can delay discharge from the hospital or surgicenter, delay the return to normal activities of daily living after discharge home, and increase medical costs. The high incidence of PONV and PDNV has persisted despite the introduction of many new antiemetic drugs (and more aggressive use of antiemetic prophylaxis) over the last two decades as a result of growth in minimally invasive ambulatory surgery and the increased emphasis on earlier mobilization and discharge after both minor and major surgical procedures (e.g. enhanced recovery protocols). Pharmacologic management of PONV should be tailored to the patient’s risk level using the validated PONV and PDNV risk-scoring systems to encourage cost-effective practices and minimize the potential for adverse side effects due to drug interactions in the perioperative period. A combination of prophylactic antiemetic drugs with different mechanisms of action should be administered to patients with moderate to high risk of developing PONV. In addition to utilizing prophylactic antiemetic drugs, the management of perioperative pain using opioid-sparing multimodal analgesic techniques is critically important for achieving an enhanced recovery after surgery. In conclusion, the utilization of strategies to reduce the baseline risk of PONV (e.g. adequate hydration and the use of nonpharmacologic antiemetic and opioid-sparing analgesic techniques) and implementing multimodal antiemetic and analgesic regimens will reduce the likelihood of patients developing PONV and PDNV after surgery.
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Affiliation(s)
| | - Paul F White
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.,The White Mountain Institute, The Sea Ranch, Sonoma, CA, 95497, USA.,Instituto Ortopedico Rizzoli, University of Bologna, Bologna, Italy
| | - Roya Yumul
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA.,David Geffen School of Medicine-UCLA, Charles R. Drew University of Medicine and Science, Los Angeles, CA, 90095, USA
| | - Hillenn Cruz Eng
- Department of Anesthesiology, PennState Hershey Medical Center, Hershey, PA, 17033, USA
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Nanthiphatthanachai A, Insin P. Effect of Chewing Gum on Gastrointestinal Function Recovery After Surgery of Gynecological Cancer Patients at Rajavithi Hospital: A Randomized Controlled Trial. Asian Pac J Cancer Prev 2020; 21:761-770. [PMID: 32212805 PMCID: PMC7437335 DOI: 10.31557/apjcp.2020.21.3.761] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Indexed: 12/24/2022] Open
Abstract
Objective: To evaluate the efficacy of postoperative gum-chewing compare with routine postoperative care on the recovery of gastrointestinal function after comprehensive surgical staging for gynecological cancer. Materials and Methods: A total of 82 patients who underwent comprehensive surgical staging for gynecological cancer at Rajavithi Hospital between October 1st, 2018 and June 30th, 2019 were randomly allocated into two groups: Gum-chewing group (n=40) and control group (n=42). In the gum-chewing group, patients were assigned to chew sugar-free gum for 30 minutes starting from the first postoperative morning then every 8 hours until the first passage of flatus. In the control group, patients have received routine postoperative care. The primary endpoint was time to first flatus after surgery. The secondary endpoints were time to first bowel sound, time to first defecation, time to first walk, postoperative analgesia and anti-emetic drug requirement, ileus symptoms, length of a hospital stay, and potential adverse events of gum-chewing, including dry mount, choking, and aspiration. Results: Chewing gum was statistically significant in reducing time to first flatus compared with routine postoperative care (median 24.7 (range 2.2-86.5) vs 35.4 (range 7.2-80.9) hours, p=0.025). The length of a hospital stay was also significantly shorter in the gum-chewing group (median 3.0 (range 1.0-8.8) vs 3.5 (range 1.8-50.0) days, p=0.023). There were no significant differences in time to first bowel sound, time to first defecation, time to first walk, postoperative analgesia and anti-emetic drug requirement, and ileus symptoms between both two groups. No adverse events related to postoperative gum-chewing were observed. Conclusion: Gum-chewing was associated with early recovery of gastrointestinal function in patients undergoing surgery for gynecological cancer. It is an inexpensive and physiologic intervention that appears to be reasonably safe and should be recommended as an adjunct in postoperative care of gynecological cancer surgery.
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Affiliation(s)
| | - Putsarat Insin
- Department of Obstetrics and Gynecology, Rajavithi Hospital, Bangkok, Thailand.,College of Medicine, Rangsit University, Bangkok, Thailand
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Bonaz B, Sinniger V, Pellissier S. Vagus Nerve Stimulation at the Interface of Brain-Gut Interactions. Cold Spring Harb Perspect Med 2019; 9:cshperspect.a034199. [PMID: 30201788 DOI: 10.1101/cshperspect.a034199] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The vagus nerve, a key component of the cross-communication between the gut and the brain, is a major element of homeostasis sensing the "milieu intérieur" and boosting the nervous and endocrine responses to maintain the gastrointestinal health status. This nerve has anti-inflammatory properties regulating the gut through the activation of the hypothalamic-pituitary-adrenal axis and the release of cortisol and through a vagovagal reflex, which has an anti-tumor necrosis factor (TNF) effect called the cholinergic anti-inflammatory pathway. Stimulating this nerve is an interesting tool as a nondrug therapy for the treatment of gastrointestinal diseases in which brain-gut communication is dysfunctional, such as inflammatory bowel disorders and others. This review presents the rationale of vagal gastrointestinal physiology and diseases and the most recent advances in vagus nerve stimulation. It also highlights the main issues to be addressed in the future to improve this bioelectronic therapy for gastrointestinal disorders.
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Affiliation(s)
- Bruno Bonaz
- Division of Hepato-Gastroenterology, Grenoble University Hospital, 38043 Grenoble Cedex 09, France.,U1216, INSERM, GIN, Grenoble Institute of Neurosciences, University Grenoble Alpes, Grenoble, France
| | - Valérie Sinniger
- Division of Hepato-Gastroenterology, Grenoble University Hospital, 38043 Grenoble Cedex 09, France.,U1216, INSERM, GIN, Grenoble Institute of Neurosciences, University Grenoble Alpes, Grenoble, France
| | - Sonia Pellissier
- University Grenoble Alpes, University Savoie Mont Blanc, 38000 Grenoble, France
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