Chewing gum for postoperative ileus after colorectal surgery: A systematic review of overlapping meta-analyses

Abstract

a b s t r a c tBackground: Many meta-analyses investigating gum chewing for postoperative recovery after colorectal surgery have been published with inconsistent findings. Therefore, we performed this study to systematically review these overlapping meta-analyses and offer clinical recommendations based on the current best evidence for decision makers. Methods: Multiple databases, including PubMed, EMBASE, Cochrane Library, Chinese BioMedical Literature on disc (CBMdisc), China National Knowledge Infrastructure (CNKI), Chinese Wanfang and Chinese VIP, were searched through October 2016. We included meta-analyses investigating the effectiveness of chewing gum for postoperative ileus after colorectal resection. Two investigators independently scanned and evaluated eligible meta-analyses, extracted essential information, assessed the methodological quality with the Assessment of Multiple Systematic Reviews (AMSTAR) tool and Oxford Levels of Evidence, and used the Jadad decision algorithm at each step for all procedures. Heterogeneity 50% was accepted. Results: Ten meta-analyses were included in our study. The AMSTAR scores varied from 5 to 9, with a median of 7.7. Most heterogeneity fell into the acceptable range. After implementing the Jadad decision algorithm, two meta-analyses of RCTs were selected based on search strategies and the implications of selection. The available best evidence indicated that gum chewing significantly reduced time to first flatus, time to first bowel movement, time to first bowel sounds and length of hospital stay. However, these two meta-analyses reached inconsistent conclusions as to the complications and economic benefits. Conclusions: With the current best available evidence, we suggest gum chewing is beneficial for gastrointestinal function and reducing postoperative ileus.

The Effect of Chewing Sugar-Free Gum to Improve Bowel Movement After Colorectal Surgeries in Patients With Colorectal Cancer

“…Despite the lack of standard clinical definitions, the incidence of POI is reported to occur in up to 1 in 4 patients who have undergone gastrointestinal surgery, making POI arguably the most frequent complication following digestive surgery (Roslan et al, 2020). Moreover, POI can cause abdominal distension, abdominal pain, nausea, vomiting, and delayed return of gastrointestinal motility (Zhang et al, 2017). These problems can delay postoperative recovery, prolong the length of hospital stay (LOS), and increase financial burden (Zhang et al, 2017).…”

“…Moreover, POI can cause abdominal distension, abdominal pain, nausea, vomiting, and delayed return of gastrointestinal motility (Zhang et al, 2017). These problems can delay postoperative recovery, prolong the length of hospital stay (LOS), and increase financial burden (Zhang et al, 2017).…”

“…The results showed that The AMSTAR scores varied from 5 to 9, with a median of 7.7. Several studies have demonstrated that gum chewing reduces the time to first flatus, first bowel movement, first bowel sounds, and LOS (Zhang et al, 2017).…”

Effect of Chewing Gum on Duration of Postoperative Ileus Following Laparotomy for Gastroduodenal Perforations: Protocol for a Randomized Controlled Trial

“…Chewing gum has been studied in different settings of surgery including colorectal, appendectomy, Gynecological operations, caesarean section and some studies have involved different abdominal surgeries including both electives and emergencies [7,12,[18][19][20].…”