Chewing gum for enhancing early recovery of bowel function after caesarean section

Abstract

This review found 17 randomised controlled trials (involving 3149 women). We downgraded the quality of the evidence for time to first passage of flatus and of faeces and for adverse effects/intolerance to gum chewing because of the high risk of bias of the studies (due to lack of blinding and self-report). For time to first flatus and faeces, we downgraded the quality of the evidence further because of the high heterogeneity in these meta-analyses and the potential for publication bias based on the visual inspection of the funnel plots. The quality of the evidence for adverse effects/tolerance to gum chewing and for ileus was downgraded because of the small number of events. The quality of the evidence for ileus was further downgraded due to the unclear risk of bias for the assessors evaluating this outcome.The available evidence suggests that gum chewing in the immediate postoperative period after a CS is a well tolerated intervention that enhances early recovery of bowel function. However the overall quality of the evidence is very low to low.Further research is necessary to establish the optimal regimen of gum-chewing (initiation, number and duration of sessions per day) to enhance bowel function recovery and to assess potential adverse effects of and women's satisfaction with this intervention. New studies also need to assess the compliance of the participants to the recommended gum-chewing instructions. Future large, well designed and conducted studies, with better methodological and reporting quality, will help to inform future updates of this review and enhance the body of evidence for this intervention.

Chewing gum for declining ileus and accelerating gastrointestinal recovery after appendectomy

“…Moreover, another study noted that the time to passage of first flatus was 7 hours earlier than those in the "typical care" control group; the time to passage of feces occurred on average 9 hours shorter in the intervention group; the average duration of hospital stay was shorter in the intervention group compared to the control group; and the first intestinal sounds were heard earlier in the intervention group than in the control group. 35 In contrast to the results of this study, in a study carried out to evaluate the effect of chewing sugared gum in combination with early enteral feeding on the recovery of gastrointestinal (GI) function after major colorectal surgery, it was demonstrated that there was no significant difference in time to tolerating a lowresidue diet, time to flatus, time to bowel movement, length of postoperative hospital stay, and postoperative complications. 36 The discrepancy may be due to two main factors.…”

Development and evaluation of an obstetric quality-of-recovery score (ObsQoR-11) after elective Caesarean delivery

“…14 Whilst the QoR-40 is a well-established scoring tool, 1 it takes approximately 10 min to complete. The previous QoR scales and other scores described in the literature, including short-term quality of life, 8 the surgical recovery index, 15 and recovery of bowel function scoring tools, 16 were not specifically designed to measure recovery in the immediate postoperative period, and omit pertinent items regarding recovery following Caesarean delivery. NRS scores for global health and pain scores, although quick to measure, do not provide a holistic indication of patient-reported functional recovery.…”

Guidelines for postoperative care in cesarean delivery: Enhanced Recovery After Surgery (ERAS) Society recommendations (part 3)

“…6 In a separate review of gum chewing after cesarean delivery, 15 clinical trials were identified. 7 The regimens for gum chewing varied widely in studies: initiation from immediately after the operation to up to 12 hours after the operation, duration of each session of 15e60 minutes, and number of sessions per day from 3 to >6. In 10 of these studies, the comparator group was traditional delayed feeding until return of intestinal function (bowel sounds or flatus).…”