Chewing Xylitol Gum could Accelerate Bowel motility Recovery after Elective Open Proctectomy for Rectal Cancer

Abstract

The present study suggests that chewing gum is a method to reduce the time to first flatus, time to first defecation and POI in patients undergoing elective open proctectomy for rectal cancer.

The Impact of Sham Feeding with Chewing Gum on Postoperative Ileus Following Colorectal Surgery: a Meta-Analysis of Randomised Controlled Trials

“…Table 1 summarises the characteristics of the sixteen included qualitative studies, ten of which were included in the quantitative synthesis. 21,23,[25][26][27][28][29][31][32][33] A total of 970 patients undergoing colorectal surgery were randomised to either postoperative chewing gum (n = 481) or routine postoperative care (n = 489).…”

“…3). 21,[31][32][33] Very Fig. 3 Incidence of postoperative ileus low heterogeneity was observed in reporting the incidence of POI.…”

“…However, after looking into descriptions of what constituted POI in each of the included studies (Table 2), we found that the four studies which reported on incidence of POI had relatively similar definitions which would limit the heterogeneity and minimise the potential for reporting bias. 21,[31][32][33] This is also reflected in the significant and homogenous outcome of the primary endpoint.…”

“…31 Another limitation of note is the temporal spread of the studies as perioperative practice has undergone many changes over the past 16 years and may well have created differences between the earliest study 12 to the most recent study. 33 Therefore 'standard care' received by patients in the control arm was probably not standardised between studies. The same undoubtedly applies for postoperative management algorithms where there has been a shift towards early resumption of oral intake, optimisation of fluid management, the selective use of anaesthesia, and the use of medications to reduce POI such as Alvimopan.…”

“…(2016) 32 Absence of adequate bowel function on postoperative day 5, or the need for the insertion of a nasogastric tube because of abdominal distension, nausea and emesis after having started a liquid diet, in the absence of mechanical obstruction Yang et al (2018) 33 Two or more episodes of nausea/vomiting, inability to tolerate oral diet over 24 h, absence of flatus over 24 h, distension and radiologic confirmation on or after postoperative day 4 without prior resolution Fig. 8 Funnel plot showing the assessment of publication bias reduction in time to passage of flatus and time to bowel movement, and no significant difference in length of hospital stay and complication rates.…”