Comparison of efficacy of simo decoction and acupuncture or chewing gum alone on postoperative ileus in colorectal cancer resection: a randomized trial

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).

Chewing Gum for Intestinal Function Recovery after Colorectal Cancer Surgery: A Systematic Review and Meta-Analysis

“…Figure 2(a) describes all of the bias classifications for the included RCTs, with the summary of qualitative methodological quality according to the bias classification (“low risk,” “unclear risk,” and “high risk”) which was presented in Figure 2(b) . Concisely, although all included RCTs mentioned randomization in their research, only nine studies [ 17 , 19 , 20 , 24 , 25 , 27 , 29 , 31 , 32 ] reported correct method of random sequence generation which marked as low risk of selection bias, and only six RCTs [ 17 , 20 , 24 , 25 , 27 , 31 ] described adequate allocation concealments, which serves as a strategy to prevent against ascertainment bias and scored as low risk of bias. In general, sequentially numbered, opaque, sealed envelopes are assigned to each participant to prevent selective bias.…”

“…Adequate blinding of personnel, participants, and outcome assessment is necessary to prevent against performance and detection bias; however, only one study [ 25 ] explicitly described how to maintain patient blinding in all included research, and six RCTs [ 17 , 24 , 25 , 27 , 29 , 31 ] had mentioned the blinding design for assessing the outcomes. Verification on selective reporting of outcomes is necessary because it may help to evaluate the integrity of outcome reporting and protect against bias, yet the majority of the included studies [ 16 , 18 – 23 , 25 – 29 , 31 , 32 ] did not provide sufficient information to assess whether an important risk of bias exists; thus, we judged the risk of other potential sources of bias as unclear. Most of the included studies appear to be free of other sources of bias except for two studies [ 26 , 32 ], so we judged the risk of bias as low risk for these trials.…”

“…All studies reported the time to the first passage of flatus, yet seven studies [ 17 , 18 , 20 , 22 , 24 , 29 , 31 ] failed to provide accurate and necessary data for further analysis. As shown in Figure 4 , we found that gum chewing probably shorten the time to first passage of flatus (WMD −0.55; 95% CI −0.94 to −0.16; P = 0.006) with a clear statistical heterogeneity across the trials ( I 2 = 78%).…”

Rapid Investigation and Screening of Bioactive Components in Simo Decoction via LC-Q-TOF-MS and UF-HPLC-MD Methods

“…It has been used abundantly to regulate gastrointestinal function and bloating in clinical applications for a thousand years [ 1 , 2 ]. Literature shows that SMD combined some methods e.g., chewing gum or acupuncture, could enhance bowel function recovery, prevent postoperative ileus, and shorten hospital stay in postoperative patients [ 3 , 4 ]. The positive effects may be due to its participation of the regulation of gastrointestinal hormones of the digestive system, and promotion of gastrointestinal motility by promoting contraction of smooth muscle [ 5 , 6 ].…”

TEAS treatment improves gastrointestinal function after abdominal surgery: study protocol for a prospective randomized controlled trial

“…The same surgical residents will listen to the bowel sounds every 4 h postoperatively. Time to first bowel motion is the duration until regular bowel sounds (more than two sounds every minute) are first heard after surgery [17] . To observe changes in plasma brain-gut peptides, such as 5-HT, substance P (SP), vasoactive gut peptide (VIP), gastrin and cholecystokinin (CCK), we will collect venous blood from patients before the operation and 1 st day and 3 rd day after the operation and then will centrifuge and freeze the plasma supernatant for later testing.…”