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Liao KL, Wang HH, Yang LY, Hsu YF, Chou FH, Chu YC. Effectiveness of Chewing Gum on Nausea and Vomiting Following Postprocedure: A Systematic Review and Meta-Analysis. J Perianesth Nurs 2024; 39:417-424.e2. [PMID: 38206218 DOI: 10.1016/j.jopan.2023.08.026] [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] [Received: 12/21/2022] [Revised: 08/05/2023] [Accepted: 08/30/2023] [Indexed: 01/12/2024]
Abstract
PURPOSE This study aimed to evaluate the effectiveness of chewing gum in reducing postprocedure nausea and vomiting. DESIGN A systematic review and meta-analysis. METHODS A systematic literature search was performed on MEDLINE Complete, EMBASE, CINAHL, PubMed, Web of Science, Academic Search Complete, and Cochrane Library databases from their inception to October 2, 2022. Methodological quality was assessed using the revised Cochrane Risk of Bias 2.0 tool for randomized trials. A meta-analysis was performed using a fixed-effects model to calculate pooled effects with Review Manager 5.4.1. FINDINGS Twelve randomized trials encompassing 1,458 participants were pooled. The chewing gum intervention was effective in reducing vomiting (P = .007; risk ratio = 0.55; 95% Cl = 0.35-0.85), but not nausea (P = .14; risk ratio = 0.84; 95% Cl = 0.66-1.06). Thirty-minute sessions of gum chewing were significantly more effective in reducing vomiting than 15-minute sessions (P = .04; risk ratio = 0.31; 95% Cl = 0.1-0.93). CONCLUSIONS The results indicate that repeated gum chewing sessions of at least 30 minutes may act as a nonpharmacological intervention for reducing vomiting. However, further studies are necessary to determine the outcomes of chewing gum interventions.
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Affiliation(s)
- Kuei-Lin Liao
- College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hsiu-Hung Wang
- College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Li-Yu Yang
- College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Yi-Fen Hsu
- College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Fan-Hao Chou
- College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan.
| | - Yi-Chin Chu
- College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan; Department of nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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Emile SH, Horesh N, Garoufalia Z, Gefen R, Ray-Offor E, Wexner SD. Strategies to reduce ileus after colorectal surgery: A qualitative umbrella review of the collective evidence. Surgery 2024; 175:280-288. [PMID: 38042712 DOI: 10.1016/j.surg.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/26/2023] [Accepted: 10/25/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND Various strategies were proposed to reduce postoperative ileus after colorectal surgery. This umbrella review aimed to provide a comprehensive overview of current evidence on measures to reduce the incidence and severity of postoperative ileus after colorectal surgery. METHODS A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic search was conducted in PubMed and Scopus to identify systematic reviews that assessed the efficacy of interventions used to prevent postoperative ileus after colorectal surgery. Data on study characteristics, interventions, and outcomes were summarized in a narrative manner. RESULTS A total of 26 systematic reviews incorporating various strategies like early oral feeding, gum chewing, coffee consumption, medications, and acupuncture were included. Early oral feeding reduced postoperative ileus and accelerated bowel function return. The most assessed intervention was chewing gum, which was associated with a median reduction of postoperative ileus by 45% (range, 11%-59%) and shortening of the time to first flatus and time to defecation by a median of 11.9 and 17.7 hours, respectively. Coffee intake showed inconsistent results, with a median shortening of time to flatus and time to defecation by 1.32 and 14.45 hours, respectively. CONCLUSION Early oral feeding, chewing gum, and alvimopan were the most commonly assessed and effective strategies for reducing postoperative ileus after colorectal surgery. Medications used to reduce postoperative ileus included alvimopan, intravenous lidocaine, dexamethasone, probiotics, and oral antibiotics. Intravenous dexamethasone and lidocaine and oral probiotics helped hasten bowel function return. Acupuncture positively impacted the recovery of bowel function.
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Affiliation(s)
- Sameh Hany Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL; Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt. https://twitter.com/dr_samehhany81
| | - Nir Horesh
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL; Department of Surgery and Transplantation, Sheba Medical Center, Ramat-Gan, Israel. https://twitter.com/nirhoresh
| | - Zoe Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL. https://twitter.com/ZGaroufalia
| | - Rachel Gefen
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL; Department of General Surgery, Faculty of Medicine, Hadassah Medical Organization, Hebrew University of Jerusalem, Israel. https://twitter.com/RachellGefen
| | - Emeka Ray-Offor
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL; Department of Surgery, University of Port Harcourt, Choba, Rivers State, Nigeria
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL.
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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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Abdelkarim H, Ciampoli N, Zwakman-Hessels L, Darvall JN, Bellomo R. Chewing gum prophylaxis for postoperative nausea and vomiting in the intensive care unit: a pilot randomised controlled trial. CRIT CARE RESUSC 2020; 22:321-326. [PMID: 38046876 PMCID: PMC10692520 DOI: 10.51893/2020.4.oa4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To test the effectiveness of chewing gum in the prophylaxis of postoperative nausea and vomiting (PONV) in patients admitted to the intensive care unit (ICU) after surgery. Design: Prospective, open label, pilot randomised controlled trial. Setting: Two metropolitan ICUs. Participants: Ninety postoperative adult patients admitted to the ICU. Intervention: Patients administered chewing gum, who chewed for at least 15 minutes every 4 hours, were compared with a control group, who were administered a 20 mL sip of water orally every 4 hours. Main outcome measures: The primary outcome was the number of patient-reported episodes of nausea in the first 24 hours after the operation. Secondary outcomes included vomiting or dry retching episodes, and duration and severity of nausea. Results: Forty-six patients were randomly allocated to chewing gum and 44 patients to water. There was no difference between groups in the number of patients with nausea (10 [22%] chewing gum v 12 [27%] control patients; P = 0.72), nausea episodes (22 episodes; [median, 0; IQR, 0-0] v 21 episodes [median, 0; IQR, 0-1] per patient in each group respectively), vomiting/retching (2 [4%] chewing gum v 6 [14%] control patients; P = 0.24), or duration/severity of nausea. Conclusion: Regular postoperative administration of chewing gum in a surgical ICU patient cohort did not reduce nausea, vomiting or retching. The prevalence of PONV is less than previously reported. Our findings can inform future studies of PONV prophylaxis in post-surgical ICU patients. Trial registration: Australian New Zealand Clinical Trial Registry No. ACTRN12617001185358.
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Affiliation(s)
- Hussam Abdelkarim
- Department of Intensive care, Ballarat Health Service, Ballarat, VIC, Australia
| | - Natasha Ciampoli
- Department of Intensive Care, Epworth Eastern, Melbourne, VIC, Australia
| | - Lara Zwakman-Hessels
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
| | - Jai N. Darvall
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Centre for Integrated Critical Care, School of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Rinaldo Bellomo
- Department of Intensive Care, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Centre for Integrated Critical Care, School of Medicine, University of Melbourne, Melbourne, VIC, Australia
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
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Öbrink E, Lerström J, Hillström C, Oddby E, Jakobsson JG. Can simple perioperative measures improve quality of recovery following ambulatory laparoscopic surgery in females? An open prospective randomised cohort study, comparing nutritional preoperative drink and chewing gum during recovery to standard care. Ann Med Surg (Lond) 2019; 44:20-25. [PMID: 31289670 PMCID: PMC6593201 DOI: 10.1016/j.amsu.2019.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 05/24/2019] [Indexed: 12/04/2022] Open
Abstract
One major goal in modern perioperative anaesthesia care is to facilitate a rapid, yet safe recovery process, with focus on improving time to regained consciousness and subsequent resuming of activities of daily living. Laparoscopic cholecystectomy and gynaecological laparoscopy are a “high volume” procedure commonly performed in young females expecting rapid resumption of health. The aim of this study was to assess whether it was possible to improve patients’ self-assessed quality of recovery in female patient undergoing laparoscopic cholecystectomy by simple perioperative measures in the form of a preoperative 200 ml nutritional drink and chewing gum during early recovery. Methods Patients were randomised to an active group receiving the intervention, and controls provided with standard care only. Patients were followed by questionnaire interviews preoperatively and at 2, 24 and 48 h after surgery. The Quality of Recovery scale (QoR) 15 items and 5 additional questions around gastro-intestinal symptoms were self-assessed by patients at each occasion. Result Seventy-three ASA 1–2 female patients’ undergoing elective laparoscopic surgery were included, surgery and anaesthesia was uneventful. The QoR score was significantly higher both at 24 and 48 h, 113 SD 20 vs 101 SD 25 (p = 0.026) and 123 SD 13 vs 111 SD 13 (p = 0.006) in the active group of patients as compared to controls. Conclusion Simply providing 200 ml nutritional preoperative drink and chewing gum during recovery was found effective, improving patients assessed quality of recovery. One major goal in modern perioperative anaesthesia care is to facilitate a rapid, yet safe recovery process. Simply providing 200 ml nutritional preoperative drink and chewing gum during recovery was found effective, improving patients self-assessed quality of recovery. Quality of recovery, assessed by a multi dimensional tool (QoR15), in females after laparoscopic surgery is still not complete 48 h after surgery.
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Affiliation(s)
- Emma Öbrink
- Department for Anaesthesia & Intensive Care, Institution for Clinical Sciences, Karolinska Institutet at Danderyd University Hospital, Stockholm, Sweden
| | - Johanna Lerström
- Department for Anaesthesia & Intensive Care, Institution for Clinical Sciences, Karolinska Institutet at Danderyd University Hospital, Stockholm, Sweden
| | - Christian Hillström
- Department for Anaesthesia & Intensive Care, Institution for Clinical Sciences, Karolinska Institutet at Danderyd University Hospital, Stockholm, Sweden
| | - Eva Oddby
- Department for Anaesthesia & Intensive Care, Institution for Clinical Sciences, Karolinska Institutet at Danderyd University Hospital, Stockholm, Sweden
| | - Jan G Jakobsson
- Department for Anaesthesia & Intensive Care, Institution for Clinical Sciences, Karolinska Institutet at Danderyd University Hospital, Stockholm, Sweden
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Byrne CM, Zahid A, Young JM, Solomon MJ, Young CJ. Gum chewing aids bowel function return and analgesic requirements after bowel surgery: a randomized controlled trial. Colorectal Dis 2018; 20:438-448. [PMID: 29053219 DOI: 10.1111/codi.13930] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 09/11/2017] [Indexed: 12/21/2022]
Abstract
AIM The aim was to compare the effectiveness of chewing sugar-free gum after bowel resection on bowel function and length of stay. METHOD This was a randomized controlled trial of patients undergoing elective open or laparoscopic bowel surgery, who were allocated into two groups: a chewing gum group (CG); or a nonchewing gum group (NG). Primary outcomes were time to discharge (length of hospital stay [LOS]), time to first flatus (TFF) and time to first bowel motion (TBM). Secondary outcomes were complication rates, pain and total morphine equivalent (TMEq) medication for 7 days after the procedure. RESULTS Between 2010 and 2013, 162 patients were randomized; four were excluded, leaving 158 in the study (82 in the CG and 76 in the NG). There was no difference in LOS between the CG (5.8 days) and the NG (6.1 days) (P = 0.403) or in the median TFF between the CG (42.0 h) and the NG (58.0 h) (P = 0.076). The median TBM was lower in the CG (40.0 h) than in the NG (90.0 h) (P = 0.002). There was no difference in intra-operative complications between the CG (9%) and the NG (9%) (P = 0.901) or in early postoperative complications (44% for CG and 55% for NG) (P = 0.131). There was no difference in TMEq at 24 h postprocedure, but the CG had reduced TMEq from days 2 to 7 post procedure and for the 7-day total. Pain was higher among patients in the NG on day 3. CONCLUSION Chewing sugar-free gum resulted in an earlier return to bowel function and decreased analgesic requirements. There was no decrease in overall LOS or postoperative complications.
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Affiliation(s)
- C M Byrne
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - A Zahid
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - J M Young
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - M J Solomon
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - C J Young
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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You X, Wang Y, Wu J, Liu Q, Liu Y, Qian Y, Chen J, Tang D, Wang D. Zusanli (ST36) Acupoint Injection with Neostigmine for Paralytic Postoperative Ileus following Radical Gastrectomy for Gastric Cancer: a Randomized Clinical Trial. J Cancer 2018; 9:2266-2274. [PMID: 30026821 PMCID: PMC6036725 DOI: 10.7150/jca.24767] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 03/16/2018] [Indexed: 02/06/2023] Open
Abstract
Background: The Zusanli (ST36) acupoint has been associated with treatment of various gastrointestinal conditions. There have been no studies of acupuncture therapy for paralytic postoperative ileus (PPOI). Materials and methods: Patients with PPOI following gastrectomy for gastric cancer were randomized to receive ST36 acupoint injection with neostigmine, gluteal intramuscular injection with 1.0 mg neostigmine, ST36 acupuncture alone, or standard therapy. The main outcome was the effectiveness rate for recovery of peristalsis. Secondary outcomes were time to bowel sound recovery, time to first flatus, and time to first defecation. Tertiary outcomes were drug-related adverse events, including abdominal pain, diarrhea, nausea, vomiting, tearing, delirium, seizure, and anxiety. Results: ST36 acupoint injection with neostigmine and gluteal intramuscular injection of neostigmine gave a higher rate of peristalsis recovery, and the ST36 acupoint injection group showed significantly higher total effectiveness rate than that of the intramuscular injection group. These interventions gave significantly shorter times to bowel sound recovery, shorter times to first flatus and first defecation compared with ST36 acupuncture and standard post-operative therapy (P < 0.01). ST36 acupoint injection group gave shorter time to bowel sound recovery, shorter time to first flatus and first defecation than those of the intramuscular injection group (P < 0.01). Drug-related adverse events in the intramuscular injection group were more serious than in the ST36 acupoint injection group (P < 0.05). Conclusion: ST36 acupoint injection with neostigmine is safe and effective for treatment of PPOI.
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Affiliation(s)
- Xiaolan You
- Department of Integrated Traditional Chinese and Western Medicine, Medical College of Yangzhou University. Yangzhou, Jiangsu Province, China
- Department of Gastrointestinal Surgery, Taizhou people's Hospital, Taizhou, Jiangsu Province, China
| | - Yuanjie Wang
- Department of Gastrointestinal Surgery, Taizhou people's Hospital, Taizhou, Jiangsu Province, China
| | - Jian Wu
- Department of Gastrointestinal Surgery, Taizhou people's Hospital, Taizhou, Jiangsu Province, China
| | - Qinghong Liu
- Department of Gastrointestinal Surgery, Taizhou people's Hospital, Taizhou, Jiangsu Province, China
| | - Yanqing Liu
- Department of Integrated Traditional Chinese and Western Medicine, Medical College of Yangzhou University. Yangzhou, Jiangsu Province, China
| | - Yayun Qian
- Department of Integrated Traditional Chinese and Western Medicine, Medical College of Yangzhou University. Yangzhou, Jiangsu Province, China
| | - Jue Chen
- Department of Integrated Traditional Chinese and Western Medicine, Medical College of Yangzhou University. Yangzhou, Jiangsu Province, China
| | - Dong Tang
- Department of Gastrointestinal Surgery, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu Province, Yangzhou Jiangsu Province, China
| | - Daorong Wang
- Department of Gastrointestinal Surgery, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu Province, Yangzhou Jiangsu Province, China
- ✉ Corresponding author: Daorong Wang, Department of Gastrointestinal Surgery, Clinical Medical College of Yangzhou University, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu Province 225000, China. e-mail:
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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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Postoperative paralytic ileus remains a problem following surgery for advanced pelvic cancers. J Surg Res 2017; 218:167-173. [DOI: 10.1016/j.jss.2017.05.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 05/07/2017] [Accepted: 05/11/2017] [Indexed: 12/11/2022]
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Liu Q, Jiang H, Xu D, Jin J. Effect of gum chewing on ameliorating ileus following colorectal surgery: A meta-analysis of 18 randomized controlled trials. Int J Surg 2017; 47:107-115. [PMID: 28867465 DOI: 10.1016/j.ijsu.2017.07.107] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 07/31/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Chewing gum, as an alternative to sham feeding, had been shown to hasten the recovery of gut function following abdominal surgery. However, conclusions remained contradictory. We sought to conduct an updated meta-analysis to evaluate the efficacy of gum chewing in alleviating ileus following colorectal surgery. METHODS We searched PubMed, EMBASE, and Cochrane Library Databases through February 2017 to identify randomized controlled trials (RCTs) evaluating the efficacy of the additional use of chewing gum following colorectal surgery. After screening for inclusion, data extraction, and quality assessment, meta-analysis was conducted by the Review Manager 5.3 software. The outcomes of interest were the time to first flatus, time to first bowel movement, length of hospital stay, and some clinically relevant parameters. We also performed subgroup analyses according to the type of surgical approaches or on trials that adopted enhanced recovery after surgery (ERAS) protocol or sugared gum. RESULTS A total of 18 RCTs, involving 1736 patients, were included. Compared with standardized postoperative care, Chewing gum resulted in a shorter passage to first flatus [WMD = -8.81, 95%CI: (-13.45, -4.17), P = 0.0002], earlier recovery of bowel movement [WMD = -16.43, 95%CI: (-22.68, -10.19), P < 0.00001], and a reduction in length of hospital stay [WMD = -0.89, 95%CI: (-1.72, -0.07), P = 0.03]. Chewing gum was also associated with a lower risk of postoperative ileus [OR = 0.41, 95%CI: (0.23, 0.73), P = 0.003]. No evidence of significant advantages in overall postoperative complication, nausea, vomiting, bloating, readmission and reoperation towards the addition of chewing gum was observed. Subgroup analyses all favored gum chewing. However, the findings are hampered by the significant heterogeneity between trials. CONCLUSIONS Based on current evidence, chewing gum offers an inexpensive, well-tolerated, safe and effective method to ameliorate ileus following colorectal surgery. However, tightly controlled, randomized and considerably larger multicenter trials are warranted to further validate our findings.
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Affiliation(s)
- Qing Liu
- Department of General Surgery, Taikang Xianlin Drum Tower Hospital, No.188 Lingshan North Road, Qixia District, Nanjing, Jiangsu Province, China
| | - Honglei Jiang
- Department of General Surgery, The Fourth Affiliated Hospital of China Medical University, No.4 Chongshan East Road, Huanggu District, Shenyang 110032, Liaoning Province, China
| | - Dong Xu
- Department of General Surgery, The Fourth Affiliated Hospital of China Medical University, No.4 Chongshan East Road, Huanggu District, Shenyang 110032, Liaoning Province, China
| | - Junzhe Jin
- Department of General Surgery, The Fourth Affiliated Hospital of China Medical University, No.4 Chongshan East Road, Huanggu District, Shenyang 110032, Liaoning Province, China.
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Yang Y, Zuo HQ, Li Z, Qin YZ, Mo XW, Huang MW, Lai H, Wu LC, Chen JS. Comparison of efficacy of simo decoction and acupuncture or chewing gum alone on postoperative ileus in colorectal cancer resection: a randomized trial. Sci Rep 2017; 7:37826. [PMID: 28102199 PMCID: PMC5244388 DOI: 10.1038/srep37826] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 11/02/2016] [Indexed: 01/21/2023] Open
Abstract
To compared the ability of chewing gum or simo decoction (SMD) and acupuncture to reduce incidence of postoperative ileus (POI) after colorectal cancer resection, patients with colorectal cancer undergoing open or laparoscopic resection were randomized to receive SMD and acupuncture (n = 196), chewing gum alone (n = 197) or no intervention (n = 197) starting on postoperative day 1 and continuing for 5 consecutive days. Patients treated with SMD and acupuncture experienced significantly shorter hospital stay, shorter time to first flatus and shorter time to defecation than patients in the other groups (all P < 0.05). Incidence of grade I and II complications was also significantly lower in patients treated with SMD and acupuncture. Patients who chewed gum were similar to those who received no intervention in terms of hospital stay, incidence of complications, and time to first bowel motion, flatus, and defecation (all P > 0.05). The combination of SMD and acupuncture may reduce the incidence of POI and shorten hospital stay for patients with colorectal cancer after resection. In contrast, chewing gum does not appear to affect recovery of bowel function or hospital stay, though it may benefit patients who undergo open resection. (Clinicaltrials.gov registration number: NCT02813278).
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Affiliation(s)
- Yang Yang
- Department of Gastrointestinal Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China
| | - Hong-Qun Zuo
- Department of Gastrointestinal Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China
| | - Zhao Li
- Department of Gastrointestinal Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China
| | - Yu-Zhou Qin
- Department of Gastrointestinal Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China
| | - Xian-Wei Mo
- Department of Gastrointestinal Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China
| | - Ming-Wei Huang
- Department of Gastrointestinal Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China
| | - Hao Lai
- Department of Gastrointestinal Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China
| | - Liu-Cheng Wu
- Department of Gastrointestinal Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China
| | - Jian-Si Chen
- Department of Gastrointestinal Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, PR China
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