Influence of gum-chewing on postoperative bowel activity after laparoscopic surgery for gastric cancer

Abstract

Background:In some studies, gum-chewing was demonstrated to have a beneficial effect on resumption of bowel function; however, other contradictory findings in other studies refute the effects of gum-chewing on peristaltic movements and digestive system stimulation. In addition, most previous studies were after colorectal or gynecology surgery, whereas few reports focused on the effect of gum-chewing after gastrectomy. The aim of this randomized controlled trial was to assess the effectiveness of gum-chewing on postoperative bowel function in patients who had undergone laparoscopic gastrectomy.Methods:From March 2014 to March 2016, 75 patients with gastric cancer received elective laparoscopic surgery in Shanghai Tongji hospital and were postoperatively randomly divided into 2 groups: 38 in a gum-chewing (Gum) group and 37 in a control (No gum) group. The patients in the Gum group chewed sugarless gum 3 times daily, each time for at least 15 minutes, until the day of postoperative exhaust defecation.Results:The mean time to first flatus (83.4 ± 35.6 vs. 79.2 ± 24.2 hours; P = 0.554) and the mean time to first defecation (125.7 ± 41.2 vs. 115.4 ± 34.2 hours; P = 0.192) were no different between the no gum and Gum groups. There was also no significant difference in the incidence of postoperative ileus (P = 0.896) and postoperative hospital stay (P = 0.109) between the 2 groups. The postoperative pain score at 48 hours (P = 0.032) in the Gum group was significantly higher than in the no gum group. There was no significant difference between the 2 groups in regards to patient demographics, comorbidities, duration of surgery, complications, and nausea/vomiting score.Conclusion:Gum-chewing after laparoscopic gastrectomy did not hasten the return of gastrointestinal function. In addition, gum-chewing may increase patient pain on the second postoperative day.

Effectivity of local bupivacaine infusion in the prevention of postoperative ileus

“…Postoperative ileus, defined as delayed defecation lasting 3-5 days accompanied by hypokinetic bowel sounds, is a frequent clinical condition occurring secondary to dissection during abdominal surgery. POI is mostly characterized by nausea, vomiting, pain, and abdominal distension, which lead to delayed healing [1,2]. Reduced gastrointestinal motility following intestinal surgery is a common complication, leading to increased incidence of POI [8,9].…”

“…Postoperative pain often leads to nausea, vomiting, and ileus, thereby resulting in longer hospital stay and increased costs [1,2]. Postoperative analgesia induced by opioids, particularly by hydromorphone equivalents, results in postoperative ileus (POI) [3].…”

“…Postoperative analgesia induced by opioids, particularly by hydromorphone equivalents, results in postoperative ileus (POI) [3]. In the reduction of postoperative pain and complications, epidural or local anesthetic practices with transfascial catheters have recently emerged as popular techniques [2]. Postoperative paralytic ileus is a difficult complication which treatment remains controversial and inconclusive [4].…”

Nutritional aspects of enhanced recovery after esophagectomy with gastric conduit reconstruction

“…Furthermore, chewing gum might have antiemetic properties that are comparable to ondansetron in the postoperative setting . Nonetheless, the role of chewing gum in accelerating the return of bowel function has not consistently been found and literature for upper gastrointestinal procedures is especially scant . No studies have investigated the role of chewing gum after esophagectomy, which may not lead to an effect through the proposed mechanism due to the vagotomy that is performed.…”

“…84 Nonetheless, the role of chewing gum in accelerating the return of bowel function has not consistently been found and literature for upper gastrointestinal procedures is especially scant. 85,86 No studies have investigated the role of chewing gum after esophagectomy, which may not lead to an effect through the proposed mechanism due to the vagotomy that is performed. Although the merits of chewing gum in the postoperative phase are questionable, it is a safe and cheap measure.…”