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Liao XQ, Li SL, Peng YC, Chen LW, Lin YJ. Effects of chewing gum on gastrointestinal function in patients following spinal surgery: a meta-analysis and systematic review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:2536-2546. [PMID: 35852608 DOI: 10.1007/s00586-022-07304-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/10/2022] [Accepted: 06/24/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE There are conflicting opinions regarding the efficacy of chewing gum for the recovery of gastrointestinal function in patients following spinal surgery. Thus, we aimed to conduct a systematic review and meta-analysis of existing articles to evaluate the effect of gum-chewing on patients following spinal surgery. METHODS A computer search was used to identify randomised controlled trials (RCTs) involving gum-chewing from eight databases: Cochrane Library, PubMed, Embase, MEDLINE, Web of Science, China National Knowledge Infrastructure, China Science and Technology Journal Database, and WanFang Data. After evaluating the risk of bias for the included studies, we used the Revman 5.3 software to conduct a meta-analysis of the data. RESULTS The study included seven RCTs, with a total of 706 patients. The meta-analysis reported that gum-chewing could shorten the interval between surgery and first bowel movement (mean deviation [MD] = - 23.02; 95% confidence interval [CI]: - 24.67, - 21.38; P < 0.00001), first flatus (MD = - 1.54; 95% CI - 2.48, - 0.60; P = 0.001), and first bowel sounds (MD = - 5.08; 95% CI - 6.02, - 4.15; P < 0.00001). Moreover, there was a significant reduction in postoperative analgesic dosage within 12 h (standardised mean difference [SMD] = - 0.28; 95% CI - 0.52, - 0.05; P = 0.02). However, there were no significant differences between the chewing gum and control groups (P > 0.05) regarding the postoperative nausea score, abdominal pain score, 24- and 48-h analgesic drug dosage, and length of hospital stay. CONCLUSION To a certain extent, masticating gum can promote the recovery of gastrointestinal function and reduce the need for postoperative analgesics in patients following spinal surgery. However, this conclusion is affected by the quantity and quality of the included articles. Therefore, additional high-quality studies are needed to verify these results.
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Affiliation(s)
- Xiao-Qin Liao
- Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, People's Republic of China
| | - Sai-Lan Li
- Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, People's Republic of China
| | - Yan-Chun Peng
- Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, People's Republic of China
| | - Liang-Wan Chen
- Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, People's Republic of China.
| | - Yan-Juan Lin
- Fujian Medical University Union Hospital, Fuzhou, 350001, Fujian, People's Republic of China.
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Qi BX, Zhu L, Sheng LP, Wen NN, Cheng X, Hu SS, Qian T. [Effect of somatostatin on postoperative gastrointestinal function and stress level in children with acute abdomen: a prospective randomized controlled study]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:812-816. [PMID: 35894198 PMCID: PMC9336631 DOI: 10.7499/j.issn.1008-8830.2203098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/08/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To study the effect of somatostatin on postoperative gastrointestinal function and stress level in children with acute abdomen. METHODS A total of 102 children with acute abdomen who underwent surgery in Xuzhou Children's Hospital from August 2019 to June 2021 were enrolled as subjects and were randomly divided into an observation group and a control group, with 51 children in each group. The children in the control group were given conventional treatment such as hemostasis and anti-infective therapy after surgery, and those in the observation group were given somatostatin in addition to conventional treatment. Peripheral blood samples were collected from both groups before surgery and on days 1 and 5 after surgery. The two groups were compared in terms of the serum levels of endothelin-1 (ET-1), adrenocorticotropic hormone (ACTH), cortisol, gastrin, and motilin, postoperative recovery, and the incidence rate of complications. RESULTS There was no significant difference in the serum levels of ET-1, ACTH, cortisol, gastrin, and motilin between the two groups before surgery (P>0.05). Compared with the control group, the observation group had significantly lower serum levels of ET-1, ACTH, and cortisol on days 1 and 5 after surgery (P<0.05) and significantly higher levels of motilin and gastrin on day 5 after surgery (P<0.05). Compared with the control group, the observation group had significantly shorter time to first passage of flatus, first bowel sounds, and first defecation after surgery, as well as a significantly shorter length of hospital stay (P<0.05). The incidence rate of complications in the observation group was significantly lower than that in the control group (6% vs 24%, P<0.05). CONCLUSIONS In children with acute abdomen, somatostatin can significantly reduce postoperative stress response, improve gastrointestinal function, and reduce the incidence rate of complications, thereby helping to achieve a good prognosis.
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Affiliation(s)
- Bo-Xiang Qi
- Surgical Intensive Care Unit, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221006, China
| | - Lei Zhu
- Surgical Intensive Care Unit, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221006, China
| | - Li-Ping Sheng
- Surgical Intensive Care Unit, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221006, China
| | - Na-Na Wen
- Surgical Intensive Care Unit, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221006, China
| | - Xiao Cheng
- Surgical Intensive Care Unit, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221006, China
| | - Shuang-Shuang Hu
- Surgical Intensive Care Unit, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221006, China
| | - Tong Qian
- Surgical Intensive Care Unit, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221006, China
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Elkan Kiyat Z, Kahyaoglu Sut H. The Effect of Xylitol Gum Chewing After Cesarean on Bowel Functions: A Randomized Controlled Study. J Perianesth Nurs 2022; 37:913-917. [PMID: 35750598 DOI: 10.1016/j.jopan.2022.03.003] [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: 01/04/2022] [Revised: 03/06/2022] [Accepted: 03/17/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE Postoperative ileus after cesarean is a common complication. The delay of bowel functions after cesarean influences early parenthood experience, increases the need for analgesic use, extends the duration of hospital stay, and causes cost increase. This study aimed to explore the effect of xylitol gum chewing after cesarean on bowel functions. DESIGN A prospective randomized controlled trial was conducted on subjects immediately after second hour of the cesarean in a ward of maternity. METHODS A total of 69 women were randomized to the xylitol gum chewing group (n = 23), the nonxylitol gum chewing group (n = 23), or the control group (n = 23). Data were collected from the women who agreed to participate and met the inclusion criteria. Starting with the second hour after the cesarean, women in the xylitol and nonxylitol gum chewing group were asked to chew gum for 15 minutes every 2 hours. The practice of chewing gum minimum of 8 hours and a maximum of 12 hours continued (until midnight). The data regarding the first times for bowel sounds, flatulation, defecation, a feeling of hunger, and length of hospital stay were compared. FINDINGS There is no difference in starting time of first bowel sounds (P = .070) and the first feeling of hunger (P = .098) among the groups. The first flatulation started at an earlier time in the xylitol gum chewing group than the control group (17.35 ± 6.27 vs 11.18 ± 5.39 hours, P = .003); first defecation time started earlier in the xylitol gum chewing group than nonxylitol gum chewing group (44.05 ± 9.4 vs 37.58 ± 9.96 hours, P = .022). Xylitol gum chewing group (51.77 ± 10.3 vs 46.33 ± 8.11 hours, P = .028) and nonxylitol gum chewing group (51.77 ± 10.3 vs 50.23 ± 5.72 hours, P = .024) were discharged from the hospital earlier than control group. CONCLUSIONS In nursing care after cesarean, early period xylitol gum chewing is an efficient and user-friendly method to prompt bowel functions earlier. Xylitol gum chewing in nursing care is suggested to be involved.
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Affiliation(s)
- Zeliha Elkan Kiyat
- Trakya University, Institute of Health Sciences, Department Nursing, Edirne, Merkez, Turkey
| | - Hatice Kahyaoglu Sut
- Trakya University, Faculty of Health Sciences, Department of Women Health and Disease Nursing, Edirne, Merkez, Turkey.
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Atkins CS, Tubog TD, Schaffer SK. Chewing Gum After Radical Cystectomy With Urinary Diversion for Recovery of Intestinal Function: A Systematic Review and Meta-Analysis. J Perianesth Nurs 2022; 37:467-473. [PMID: 35272926 DOI: 10.1016/j.jopan.2021.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/24/2021] [Accepted: 10/09/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE To evaluate the efficacy of chewing in the recovery of intestinal function after radical cystectomy. DESIGN Systematic review and meta-analysis. METHODS Following the PRISMA statement, PubMed, CINAHL, Google Scholar, Cochrane Review Database, EMBASE, Scopus, and grey literature were searched for evidence. FINDINGS The analysis included 2 trials with 100 patients. Compared to placebo, chewing gum resulted in faster recovery of bowel function (mean difference [MD], -16.00; 95% confidence interval [CI], -18.67 to -13.32; P < .00001). In addition, chewing gum decreased the time to flatus (MD, -14.81; 95% CI, -22.14 to -7.47; P < .0001), but did not reduced the length of stay (MD, 0.97; 95% CI, -1.23 to 3.18; P = .39) and the incidence of postoperative ileus (risk ratio, 0.67; 95% CI, 0.20-2.23; P = .51). The quality of evidence is low due to imprecision and suspected publication bias. CONCLUSIONS Chewing gum appears to be an inexpensive intervention to improve the return of bowel function in patients undergoing radical cystectomy.
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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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Peng Y, Peng C. Acute colonic pseudo-obstruction with bowel rupture after caesarean section in HELLP syndrome: a case report. BMC Pregnancy Childbirth 2020; 20:727. [PMID: 33238905 PMCID: PMC7687834 DOI: 10.1186/s12884-020-03414-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/12/2020] [Indexed: 12/17/2022] Open
Abstract
Background Ogilvie syndrome, also known as acute colonic pseudo-obstruction (ACPO), can occur postpartum after caesarean section (C-section), often resulting in caecal dilatation. The incidence rate is approximately 100 cases in 100,000 patients per year (Ross et al., Am Surg 82:102-11, 2016). Without proper diagnosis and treatment, it may progress to intestinal perforation or other fatal complications. Case presentation A 39-year-old pregnant woman underwent emergency low-segment C-section due to complications of Haemolysis, Elevated Liver enzymes and Low Platelets syndrome (HELLP) syndrome. ACPO was suspected on the third day after C-section based on inability to pass flatus, evident abdominal distension, slight abdominal pain, and computed tomography (CT) scan revealing severe, diffuse colonic distention with caecal dilatation of approximately 9 cm. Based on these findings, conservative treatment was implemented. However, 6 days after C-section, her symptoms worsened, and CT showed possible intestinal perforation; thus, an emergency laparotomy was performed. Due to a 3-cm (diameter) laceration in the anterolateral wall of the ascending colon and a 5-cm tear in the ileocecal junction, in combination with mucosal eversion in the colon, resection of the ileocecum, distal closure of the ascending colon, and a terminal ileostomy were performed. The patient was discharged 2 weeks post-laparotomy and continued to undergo nursing care for the incision and stoma. Ileostomy was performed 4 months later. Conclusion Ogilvie syndrome after C-section is an extremely rare but severe condition, which warrants early recognition and treatment to prevent potentially fatal complications, especially in patients with poor health status.
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Affiliation(s)
- Ying Peng
- Department of Obstetrics and Gynaecology, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, 17, Lu Jiang Road, Hefei, 230001, Anhui, P. R. China.
| | - Cheng Peng
- Department of Obstetrics and Gynaecology, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, 17, Lu Jiang Road, Hefei, 230001, Anhui, P. R. China
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Wen Z, Xie A, Peng M, Bian L, Wei L, Li M. Is discard better than return gastric residual aspirates: a systematic review and meta-analysis. BMC Gastroenterol 2019; 19:113. [PMID: 31253100 PMCID: PMC6599274 DOI: 10.1186/s12876-019-1028-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 06/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The assessment of residual gastric volume is common practice in critical care units. However, the effects and safety of discarding or returning gastric aspirates remain uncertain. Therefore, we aimed to evaluate the role of discarding or returning gastric aspirates on the gastric residual volumes in critically ill patients. METHODS A comprehensive, systematic meta-analysis of randomized controlled trials (RCTs) on the efficacy and safety of discarding or returning gastric aspirates in critical ill patients was performed. Studies were identified by searching Pubmed and other databases (from inception to 31 Sept 2018). Summary odd ratios (ORs) or mean differences (MDs) with 95% confidence intervals were calculated using fixed- or random-effects model for outcome assessment. RESULTS Four RCTs, with a total number of 314 adult patients, were included in the analysis. No significant differences were found in the 48th hour residual volume (MD = 8.89, 95% CI: 11.97 to 29.74), the average potassium level (MD = 0.00, 95% CI: - 0.16 to 0.16), the episodes of gastric emptying delay (OR = 0.98, 95% CI: 0.35 to 2.80), the incidence of aspiration pneumonia (OR = 0.93, 95% CI: 0.14 to 6.17), the episodes of nausea or vomiting (OR = 0.53, 95% CI: 0.07 to 4.13) and diarrhea (OR = 0.99, 95% CI: 0.58 to 1.70). CONCLUSIONS No evidence confirms that returning residual gastric aspirates provides more benefits than discarding them without increasing potential complications. Rigorously designed, multi-center, large-sample randomized controlled trials must be further conducted to validate the role of discarding or returning residual gastric aspirates.
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Affiliation(s)
- Zunjia Wen
- Children's Hospital of Nanjing Medical University, No.72 Guangzhou road, Gulou district, Nanjing, Jiangsu province, China
| | - Ailing Xie
- Children's Hospital of Nanjing Medical University, No.72 Guangzhou road, Gulou district, Nanjing, Jiangsu province, China
| | - Mingqi Peng
- Children's Hospital of Nanjing Medical University, No.72 Guangzhou road, Gulou district, Nanjing, Jiangsu province, China
| | - Lanzheng Bian
- Children's Hospital of Nanjing Medical University, No.72 Guangzhou road, Gulou district, Nanjing, Jiangsu province, China
| | - Li Wei
- Children's Hospital of Nanjing Medical University, No.72 Guangzhou road, Gulou district, Nanjing, Jiangsu province, China
| | - Mei Li
- Children's Hospital of Nanjing Medical University, No.72 Guangzhou road, Gulou district, Nanjing, Jiangsu province, China.
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Berghella V, Saccone G, Ciardulli A, Di Mascio D, Caissutti C. Reply to letter to the editor regarding the article: chewing gum improves postoperative recovery of gastrointestinal function after cesarean delivery: a systematic review and meta-analysis of randomized trials. J Matern Fetal Neonatal Med 2019; 33:2311. [PMID: 30614313 DOI: 10.1080/14767058.2018.1545389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Vincenzo Berghella
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Thomas Jefferson University, 833 Chestnut, Philadelphia, Pennsylvania, USA
| | - Gabriele Saccone
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples "Federico II", Naples, Italy
| | - Andrea Ciardulli
- University of Roma Tor Vergata, Division of Maternal Fetal Medicine, Ospedale Cristo Re Roma, Rome, Italy
| | - Daniele Di Mascio
- Department of Gynecological, Obstetrical and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Claudia Caissutti
- Department of Experimental Clinical and Medical Science, DISM, Clinic of Obstetrics and Gynecology, University of Udine, Udine, Italy
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Yenigul NN, Aydogan Mathyk B, Aslan Cetin B, Yazici Yilmaz F, Ayhan I. Efficacy of chewing gum for improving bowel function after cesarean sections: a randomized controlled trial. J Matern Fetal Neonatal Med 2019; 33:1840-1845. [PMID: 30606082 DOI: 10.1080/14767058.2018.1531122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective: To investigate the effects of chewing xylitol-free gum at different intervals after cesarean sections.Study design: One hundred fifty patients undergoing cesarean sections were randomized into a gum chewing group (n = 75) and a control group (n = 75). Patients in the gum group chewed one sugarless gum for 30 min at 3, 5, and 7 h postoperatively. The two groups were compared in terms of time to first bowel movement, first feeling of hunger, first passage of flatus, and defecation time. Postoperative satisfaction with bowel movements was rated on a scale of 1-5.Results: First bowel movement time (4.93 ± 1.05 versus 7.97 ± 2.33 h postoperatively, p = .0001), first feeling of hunger (5.51 ± 1.68 versus 6.30 ± 1.58 h postoperatively, p = .004), first passage of flatus (11.73 ± 4.61 versus 14.10 ± 2.71 h postoperatively, p = .001), and mean length of hospital stay (2.30 ± 0.49 versus 2.50 ± 0.50 d, p = .015) were significantly reduced in the gum group compared with the control group. Postoperative satisfaction scores for overall bowel function were better in the patients who chewed gum.Conclusion: Gum chewing at frequent intervals in the early postoperative period promotes the early return of bowel movements, shortens hospitalization, and increases patient satisfaction regarding bowel function.
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Affiliation(s)
- Nefise Nazlı Yenigul
- Department of Obstetrics and Gynecology, School of Medicine, Sanlıurfa Mehmet Akif Inan Research and Training Hospital, University of Health Sciences, Sanlıurfa, Turkey.,Department of Obstetrics and Gynecology, Sisli Etfal Research and Training Hospital, Istanbul, Turkey
| | - Begum Aydogan Mathyk
- Department of Obstetrics and Gynecology, Sisli Etfal Research and Training Hospital, Istanbul, Turkey.,Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, University of North Carolina, Chapel Hill, NC, USA
| | - Berna Aslan Cetin
- Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey
| | - Fatma Yazici Yilmaz
- Department of Obstetrics and Gynecology, Sisli Etfal Research and Training Hospital, Istanbul, Turkey
| | - Isıl Ayhan
- Department of Obstetrics and Gynecology, Sisli Etfal Research and Training Hospital, Istanbul, Turkey.,Department of Obstetrics and Gynecology, Zeynep Kamil Research and Training Hospital, Istanbul, Turkey
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Altraigey A, Ellaithy M, Atia H, Abdelrehim W, Abbas AM, Asiri M. The effect of gum chewing on the return of bowel motility after planned cesarean delivery: a randomized controlled trial. J Matern Fetal Neonatal Med 2018; 33:1670-1677. [PMID: 30231787 DOI: 10.1080/14767058.2018.1526913] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective: To endorse the impact of chewing gum on the intestinal functions' restoration, hospital stay and gastrointestinal complications after planned cesarean delivery (CD).Methods: Women aged between 20 and 35 years scheduled for planned CD; either first or repeated, with term, singleton, viable and healthy pregnancy at obstetrics and gynecology department, Armed Forces Hospital Southern Region, Khamis Mushayt, Saudi Arabia were invited to participate and randomized if eligible into three groups. The first group chewed sugar-free gum 2 h after recovery at least for half an hour and at 2-h interval during daytime. The second group received oral fluids 6 h postoperatively, while the third group was the control group. The primary outcome measure was the time to first passage of stool. The secondary outcomes included the time of the first passage of flatus, the first hearing of normal intestinal sounds, the duration of hospital stay the duration of parenteral therapy by intravenous fluids, the time of initiating breast-feeding and the cost of hospital stay. The study was prospectively registered at ClinicalTrials.gov (NCT02386748).Results: The study included 372 women randomized into three groups (124 women in each group). Chewing gum significantly improved intestinal recovery with faster onset of bowel movements, first audible intestinal sounds, passage of flatus and passage of stool (p = .0001). It was associated with significantly shorter duration of hospital stay and parenteral therapy duration (p = .0001). Abdominal distension, vomiting and ileus postoperatively were significantly higher in nonchewing gum groups. Neither paralytic ileus nor side effects were recorded with gum use.Conclusion: Chewing gum, within 2 h postoperatively, is a simple, safe and well-tolerated intervention that can boost rapid intestinal recovery and shorten hospital stay after planned cesarean deliveries.
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Affiliation(s)
- Ahmed Altraigey
- Department of Obstetrics and Gynaecology, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia.,Department of Obstetrics and Gynaecology, Benha University, Benha, Egypt
| | - Mohamed Ellaithy
- Department of Obstetrics and Gynaecology, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia.,Department of Obstetrics and Gynaecology, Ain Shams University, Cairo, Egypt
| | - Hytham Atia
- Department of Obstetrics and Gynaecology, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia.,Department of Obstetrics and Gynaecology, Zagazig University, Zagazig, Egypt
| | - Wegdan Abdelrehim
- Department of Obstetrics and Gynaecology, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
| | - Ahmed M Abbas
- Department of Obstetrics and Gynaecology, Assiut University, Assiut, Egypt
| | - Mufareh Asiri
- Department of Obstetrics and Gynaecology, Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia
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Akalpler O, Okumus H. Gum chewing and bowel function after Caesarean section under spinal anesthesia. Pak J Med Sci 2018; 34:1242-1247. [PMID: 30344584 PMCID: PMC6191783 DOI: 10.12669/pjms.345.15772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Objective: To determine the effect of gum chewing on bowel function postoperatively in women after cesarean delivery under spinal anesthesia. Methods: This semi-experimental study was conducted at Near East University Hospital Obstetrics and Gynecology Clinic in Turkish Republic of Northern Cyprus with 45 women in both the +experimental and control groups, between October 2016 and June 2017. The women in the experimental group chewed gum two hours after surgery until gut sounds were heard and nutrition was given orally. Results: The mean age of the women was 30.20 ± 4.88 in the experimental group and 30.85 ± 4.47 in the control group. In the control group, the mean time of flatulation was 26.33 ± 7.54 hours, whereas the mean time was 13.44 ± 6.56 hours in the experimental group. The mean duration to the hearing of intestinal sounds was 16.35 ± 5.20 hours in the control group and 12.62 ± 7.73 hours in the experimental group. Conclusion: The results of the present study indicate that sugar free gum chewing in the post-operative period which is cesarean section under spinal anesthesia shortened the duration of the intestinal movement, the time of first flatulation, and discharge time.
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Affiliation(s)
- Ozlem Akalpler
- Ozlem Akalpler, M.Sc. Department of Obstetrics, Women's Health and Gynecology, Faculty of Nursing, Near East University, Nicosia, Cyprus
| | - Hulya Okumus
- Prof. Dr. Hulya Okumus, Department of Obstetrics, Women's Health and Gynecology, Faculty of Nursing, 9 Eylul University, Izmir, Turkey
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Park SH, Choi MS. Meta-Analysis of the Effect of Gum Chewing After Gynecologic Surgery. J Obstet Gynecol Neonatal Nurs 2018; 47:362-370. [PMID: 29505755 DOI: 10.1016/j.jogn.2018.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2018] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To describe the scientific evidence related to gum chewing to reduce ileus after gynecologic surgery. DATA SOURCES A literature search was performed using Ovid Medline, Embase, Cochrane Library, CINAHL, Scopus, and Web of Science databases. STUDY SELECTION Inclusion criteria included randomized controlled trials (RCTs) on the use of gum chewing after gynecologic surgery in which the main outcomes measured were time to first flatus, time to defecation, and length of hospital stay. DATA EXTRACTION Data on authors, country, randomization method, the type of disease, surgical and anesthetic methods, sample characteristics such as age and body mass index, gum chewing program, and study results were extracted from selected articles. DATA SYNTHESIS Of 493 publications, eight RCTs conducted between 2013 and 2017 involving 1,077 women were included in our meta-analysis. Weighted mean differences (WMDs) with 95% confidence intervals were calculated for the eight studies with the use of Cochrane Review Manager Version 5.3 (RevMan; 2014). The pooled results showed that gum chewing was superior to no gum chewing, with a reduction in WMD for time to first flatus of -6.20 hours (95% confidence interval [CI] [-9.51, -2.88]), WMD for time to first defecation of -9.03 hours (95% CI [-14.02, -4.04]), and WMD for length of hospital stay of -0.36 days (95% CI [-0.72, -0.01]). CONCLUSION Gum chewing significantly reduced the time to first flatus and defecation after gynecologic surgery and should be recommended by health care providers.
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Chewing Gum for Intestinal Function Recovery after Colorectal Cancer Surgery: A Systematic Review and Meta-Analysis. Gastroenterol Res Pract 2017; 2017:3087904. [PMID: 29312450 PMCID: PMC5651113 DOI: 10.1155/2017/3087904] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 08/21/2017] [Accepted: 09/06/2017] [Indexed: 12/18/2022] Open
Abstract
Background This meta-analysis was performed to assess the efficacy and safety of chewing gum in intestinal function recovery after colorectal cancer surgery. Methods A systematic search was conducted in PubMed, Embase, Science Direct, and Cochrane library for relevant randomized controlled trials (RCTs) published until April 2017. Summary risk ratios or weighted mean differences with 95% confidence intervals were used for continuous and dichotomous outcomes, respectively. Results 17 RCTs with a total number of 1845 patients were included. Gum chewing following colorectal cancer surgery significantly reduced the time to first passage of flatus (WMD −0.55; 95% CI −0.94 to −0.16; P = 0.006), first bowel movement (WMD −0.60; 95% CI −0.87 to −0.33; P < 0.0001), start feeding (WMD −1.32; 95% CI −2.18 to −0.46; P = 0.003), and the length of postoperative hospital stay (WMD −0.88; 95% CI −1.59 to −0.17; P = 0.01), but no obvious differences were found in postoperative nausea, vomiting, abdominal distention, pneumonia, and mortality, which were consistent with the findings of intention to treat analysis. Conclusions Chewing gum could accelerate the recovery of intestinal function after colorectal cancer surgery. However, it confers no advantage in postoperative clinical complications. Further large-scale and high-quality RCTs should be conducted to confirm these results.
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[Does chewing gum improve postoperative results in patients undergoing radical cystectomy? A systematic review of literature and meta-analysis]. Prog Urol 2017; 27:513-520. [PMID: 28734774 DOI: 10.1016/j.purol.2017.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/06/2017] [Accepted: 06/13/2017] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Postoperative ileus occurs in different degrees, in the majority of patients undergoing radical cystectomy, which may increase the length of hospital stay. The use of chewing gum has demonstrated its effectiveness in reducing time-to-bowel function and the length of hospital stay in several surgical procedures. OBJECTIVE To evaluate the benefit of post-operative chewing gum use in patients undergoing radical cystectomy through a systematic review of the literature and meta-analysis. MATERIAL AND METHODS We performed a literature search of MedLine, Scopus, CochraneLibrary and ClinicalTrials.Gov in March 2017 according to the Cochrane Handbook and the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes. The studies were evaluated according to the "Oxford Center for Evidence-Based Medicine" criteria. The outcome measures evaluated were time-to-flatus, time-to-defecation, length of the hospital stay, and the rates of general and gastrointestinal postoperative complications. Continuous and dichotomous variables were compared respectively using weighted means differences and odds ratios with 95 % confidence intervals. The presence of publication bias was examined by funnel plots. RESULTS Three studies (including 274 patients in total) met the inclusion criteria. The pooled results demonstrated a 11.82hour reduction in time-to-flatus (95 % CI : -15.43, -8.22h, P <0.00001), and 19.57hours in time-to-defecation (95 % CI : -29.33, -9.81h, P <0.0001), and a decreasing trend of 2.85 days in the length of the hospital stay (95 % CI : -6.13, -0.43, P=0.09), by the use of chewing gum. There was no significant difference between the "chewing gum" and "control" groups in terms of general and gastrointestinal complications (Peto Odds ratio 1.04 [0.60, 1.79], 95 % CI, P=0.89 and Peto Odds ratio 0.65 [0.26, 1.61], 95 % CI, P=0.35 respectively). CONCLUSION Chewing gum may be recommended postoperatively in patients undergoing radical cystectomy to improve time-to-bowel function.
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Ciardulli A, Saccone G, Di Mascio D, Caissutti C, Berghella V. Chewing gum improves postoperative recovery of gastrointestinal function after cesarean delivery: a systematic review and meta-analysis of randomized trials. J Matern Fetal Neonatal Med 2017; 31:1924-1932. [PMID: 28502203 DOI: 10.1080/14767058.2017.1330883] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To examine whether chewing gum hastens the return of gastrointestinal function after a cesarean delivery. METHODS All randomized controlled trials comparing the use of chewing gum in the immediate postoperative recovery period (i.e. intervention group) with a control group were included in the meta-analysis. The primary outcome was the time to first flatus in hours. Meta-analysis was performed using the random effects model of DerSimonian and Laird, to produce summary treatment effects in terms of mean difference (MD) or relative risk (RR) with 95% confidence interval (CI). RESULTS Seventeen trials, including 3041 women, were analyzed. Trials were of moderate to low quality with different inclusion criteria. In most of the included trials chewing gum was given right after delivery, three times a day for 30 min each and until the first flatus. Women who were randomized to the chewing gum group had a significantly lower mean time to first flatus (MD - 6.49 h, 95%CI -8.65 to -4.33), to first bowel sounds (MD - 8.48 h, 95%CI -9.04 to -7.92), less duration of stay (MD - 0.39 days, 95%CI -0.78 to -0.18), lower time to first feces (MD - 9.57 h, 95% CI -10.28 to 8.87) and to the first feeling of hunger (MD - 2.89 h, 95%CI -4.93 to -0.85), less number of episodes of nausea or vomiting (RR 0.33, 95%CI 0.12 to 0.87), less incidence of ileus (RR 0.39, 95%CI 0.19 to 0.80) and significantly higher satisfaction. CONCLUSIONS Gum chewing starting right after cesarean delivery three times a day for about 30 min until the first flatus is associated with early recovery of bowel motility. As this is a simple, generally inexpensive intervention, providers should consider implementing cesarean postoperative care with gum chewing.
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Affiliation(s)
- Andrea Ciardulli
- a Department of Obstetrics and Gynecology , Catholic University of Sacred Heart , Rome , Italy
| | - Gabriele Saccone
- b Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine , University of Naples Federico II , Naples , Italy
| | - Daniele Di Mascio
- c Department of Obstetrics and Gynecology , University of Sapienza , Rome , Italy
| | - Claudia Caissutti
- d Department of Experimental Clinical and Medical Science, DISM, Clinic of Obstetrics and Gynecology , University of Udine , Udine , Italy
| | - Vincenzo Berghella
- e Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology , Sidney Kimmel Medical College of Thomas Jefferson University , Philadelphia , PA , USA
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