Chewing gum for postoperative recovery of gastrointestinal function

Short, Vaneesha; Herbert, Georgia; Perry, Rachel; Atkinson, Charlotte; Ness, Andy R; Penfold, Chris; Thomas, Steven J.; Andersen, Henning; Lewis, Stephen J.

doi:10.1002/14651858.cd006506.pub3

Cited by 123 publications

(124 citation statements)

References 79 publications

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“…In the study by Hendry et al [89], the routine use of postoperative laxatives resulted in an earlier first passage of stool, but the overall rate of recovery was unaltered in liver surgery patients. The use of chewing gum (CG) after surgery has been addressed in a large Cochrane review [104]. This meta-analysis showed no clear benefit of CG in ERAS patients and included few patients with liver surgery.…”

Section: Stimulation Of Bowel Movementmentioning

confidence: 99%

Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations

et al. 2016

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Background Enhanced Recovery After Surgery (ERAS) is a multimodal pathway developed to overcome the deleterious effect of perioperative stress after major surgery. In colorectal surgery, ERAS pathways reduced perioperative morbidity, hospital stay and costs. Similar concept should be applied for liver surgery. This study presents the specific ERAS Society recommendations for liver surgery based on the best available evidence and on expert consensus. Methods A systematic review was performed on ERAS for liver surgery by searching EMBASE and Medline. Five independent reviewers selected relevant articles. Quality of randomized trials was assessed according to the Jadad score and CONSORT statement. The level of evidence for each item was determined using the GRADE system. The Delphi method was used to validate the final recommendations. Results A total of 157 full texts were screened. Thirty-seven articles were included in the systematic review, and 16 of the 23 standard ERAS items were studied specifically for liver surgery. Consensus was reached among experts after 3 rounds. Prophylactic nasogastric intubation and prophylactic abdominal drainage should be omitted. The use of postoperative oral laxatives and minimally invasive surgery results in a quicker bowel recovery and shorter hospital stay. Goal-directed fluid therapy with maintenance of a low intraoperative central venous pressure induces faster recovery. Early oral intake and mobilization are recommended. There is no evidence to prefer epidural to other types of analgesia. Conclusions The current ERAS recommendations were elaborated based on the best available evidence and endorsed by the Delphi method. Nevertheless, prospective studies need to confirm the clinical use of the suggested protocol.

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Section: Stimulation Of Bowel Movementmentioning

confidence: 99%

Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations

et al. 2016

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“…Conversely, the role of chewing gum (sham feeding) and pro-kinetic agents, when used as targeted postoperative therapies, remains contentious [4,31]. NSAIDs have been recommended for the prevention and reduction of POI and are included in some enhanced recovery protocols for postoperative analgesia [7].…”

Section: Discussionmentioning

confidence: 99%

“…However, complex interactions between interventions and unstandardized outcome measures have limited their translation into clinical practice [4][5][6]. Enhanced recovery protocols employ multimodal strategies to optimize postoperative recovery [7].…”

Section: Introductionmentioning

confidence: 99%

Ileus Management International (IMAGINE): protocol for a multicentre, observational study of ileus after colorectal surgery

2018

Colorectal Disease

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Aim The management of postoperative ileus following colorectal surgery remains controversial. It is the commonest complication after elective colorectal resection and is associated with an increased incidence of postoperative adverse events. The prevention and management of postoperative ileus remains unstandardized. This study aims to describe an international profile of gastrointestinal recovery after colorectal surgery and will assess the role of non-steroidal anti-inflammatory drugs, when used as postoperative analgesia, in expediting the return of gastrointestinal function.Methods A multicentre, student-and trainee-led, prospective cohort study will be conducted across both Europe and Australasia. Adult patients undergoing elective colorectal resection during 2-week data collection periods between January and April 2018 will be included. A site-specific questionnaire will capture compliance to Enhanced Recovery after Surgery components at participating centres. The primary outcome is time to gastrointestinal recovery, measured using a composite outcome of bowel function and oral tolerance. The impact of non-steroidal anti-inflammatory drugs on gastrointestinal recovery will be evaluated along with safety data with respect to anastomotic leak, acute kidney injury and complications within 30 days of surgery.Discussion This protocol describes the methodology of an international, observational assessment of gastrointestinal recovery after colorectal surgery. It discusses key challenges and describes how the results will impact on future investigation. The study will be conducted across a large student-and trainee-led collaborative network, with prospective quality assurance and data validation strategies.

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“…The sources included the clinical question for the population of patients, interventions, outcome measures, settings and selection criteria (inclusion criteria and exclusion criteria), use of the selection criteria, literature search strategies, data abstraction, end points, human error (random or systematic), study quality assessment, quality assessment interpretations and methods of quality assessments in reviews, ability to combine studies through clinical criteria and statistical methods, and statistical methods for data analysis. 14 After implementing the Jadad algorithm, two meta-analyses completed by Short et al 21 and Song et al 23 were selected to provide clinical treatment recommendations on the effect of chewing gum after colorectal resection for postoperative ileus based on the current best available evidence to promote decisionmaking in a clinical context. Short and colleagues 21 demonstrated that there was statistical evidence that the use of gum chewing reduced time to first flatus, time to first defecation, time to bowel sounds and length of hospital stay.…”

Section: Discussionmentioning

confidence: 99%

“…The last criterion did not apply to our study. After application of the aforementioned criteria, we ultimately selected two meta-analyses written by Short et al 21 and Song et al 23 (Fig. 2).…”

Section: Assessing Heterogeneitymentioning

confidence: 99%

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

Zhang¹,

Deng²,

Shuai³

et al. 2017

Chinese Nursing Research

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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.

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Chewing gum for postoperative recovery of gastrointestinal function

Cited by 123 publications

References 79 publications

Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations

Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations

Ileus Management International (IMAGINE): protocol for a multicentre, observational study of ileus after colorectal surgery

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

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