Multicentre randomized clinical trial of the effect of chewing gum after abdominal surgery

Leede, Eleonora M. de; Leersum, N.J. van; Kroon, Hidde M.; Weel, Chris van; Sijp, Joost R.M. van der; Bonsing, Bert A.

doi:10.1002/bjs.10828

Cited by 55 publications

(40 citation statements)

References 53 publications

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“…The evidence, however, was considered to be of low quality and limited external validity, owing to small sample sizes (with the average number of patients per trial ranging from 20 to 50), the absence of a perioperative ERPs setting and the limited diversity of surgical procedures. The results of this review have also since been refuted by a recent large multicentre RCT by de Leede et al . which found that the addition of chewing gum to an institutionalized ERP following elective abdominal surgery did not decrease the LOS, time to first flatus or time to first defecation.…”

Section: Discussionmentioning

confidence: 80%

“…As per the evidence strength assessment reported in the included studies, the evidence for oral laxatives, including magnesium‐based laxatives was reported to be weak for all outcome measures. The evidence for chewing gum in achieving the return of GI function changed from moderate/strong in earlier papers to weak in later papers because of available newer evidence . Alvimopan was reported to have moderate to strong evidence for improving return of GI function, reduction in the incidence of ileus, and reduced day stay, especially in patients undergoing laparotomy …”

Section: Resultsmentioning

confidence: 99%

“…However, while these protocols use multimodal strategies to optimize post‐operative recovery, the incidence of POI has been largely stable and recalcitrant. This may be because of a dearth of available evidence on how to prevent and treat POI, with published data providing varied and conflicting results . This probably also explains the lack of uniformity in recommendations targeting POI in different ERPs published worldwide.…”

Section: Introductionmentioning

confidence: 99%

“…This may be because of a dearth of available evidence on how to prevent and treat POI, with published data providing varied and conflicting results. [10][11][12][13] This probably also explains the lack of uniformity in recommendations targeting POI in different ERPs published worldwide.…”

Section: Introductionmentioning

confidence: 99%

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Systematic scoping review of enhanced recovery protocol recommendations targeting return of gastrointestinal function after colorectal surgery

Dudi-Venkata

Kroon

Bedrikovetski

et al. 2019

ANZ Journal of Surgery

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Background Post‐operative ileus (POI) and delayed return of gastrointestinal (GI) function are common complications after colorectal surgery. There is a lack of uniformity in enhanced recovery protocols (ERPs) with regards to interventions used to target these complications. This systematic review aims to categorize and summarize management recommendations available from published ERPs. Methods A systematic search of Ovid MEDLINE, Embase, Cochrane Library and PubMed databases was performed from January 1990 to May 2018. All studies publishing enhanced recovery or fast‐track or multimodal pathway protocols for colorectal surgery in their full‐text were included. Data on interventions aimed at reducing the duration of POI were extracted, as well as references quoted to support specific interventions. Results Of 481 manuscripts screened, 37 published ERPs were identified from 37 studies (18 cohort, seven historical‐control, five guidelines, four randomized controlled trials, one randomized controlled trial protocol, one case series and one narrative review). The most commonly recommended interventions were magnesium‐based laxatives (18 of 37, 48.6%), chewing gum (13 of 37, 35.1%), Alvimopan (6 of 37, 16.2%), lactulose (4 of 37, 10.8%), neostigmine (2 of 37, 5.4%) and bisacodyl (2 of 37, 5.4%). Geographical trends were noted for the various interventions, but high‐quality evidence was only referenced to support the use of Alvimopan. Conclusion ERP recommendations specific to interventions targeting POI and return of GI function are varied. While laxatives are the most commonly recommended intervention, there is only weak evidence reported to support this practice.

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Section: Discussionmentioning

confidence: 80%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Systematic scoping review of enhanced recovery protocol recommendations targeting return of gastrointestinal function after colorectal surgery

Dudi-Venkata

Kroon

Bedrikovetski

et al. 2019

ANZ Journal of Surgery

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“…Two old favourites resurfaced on Twitter last month: an RCT from last year on the role of chewing gum for ileus after abdominal surgery (tweeted by Stephen Chapman, @SJ_Chapman), and Mokhles et al . 's paper from 2016 on colorectal cancer follow‐up after potentially curative resection, discussed at the Exeter Journal Club.…”

mentioning

confidence: 99%

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2019

British Journal of Surgery

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Real‐time bowel sound analysis using newly developed device in patients undergoing gastric surgery for gastric tumor

Namikawa¹,

Yamaguchi²,

Fujisawa³

et al. 2021

JGH Open

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Background and Aim Objective measurements are not available for determining bowel sounds. The present study sought to evaluate the efficacy of a novel bowel sound monitoring system for perioperative use in patients undergoing gastric surgery. Methods The study enrolled 14 patients who underwent surgery for gastric cancer at Kochi Medical School from 2017 to 2018. Preoperative and postoperative bowel sounds were recorded using a newly developed real‐time analysis system in the operating theater and recovery room. Clinical information and bowel sound count data were obtained to compare preoperative and postoperative measures. Results The median preoperative and postoperative bowel sound counts across all patients were 1.4 and 2.5 counts per minute (cpm), respectively. In patients who underwent laparoscopic gastrectomy, the postoperative bowel sound count was significantly higher than that recorded preoperatively (2.3 vs. 1.6 cpm, P = 0.005). The findings also revealed a significant negative correlation between postoperative bowel sound count and operation time (r = −0.714, P = 0.003). Conclusions The real‐time bowel sound analysis system tested herein presents a promising diagnostic tool to quantitatively evaluate bowel movements associated with surgery. Our results suggested a need for shorter operation times for gastric procedures with respect to peristalsis recovery and supported the use of minimally invasive surgery.

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Multicentre randomized clinical trial of the effect of chewing gum after abdominal surgery

Abstract: The addition of chewing gum to an ERAS postoperative care pathway after elective abdominal surgery does not reduce the LOS, time to bowel recovery or the rate of postoperative complications. Registration number: NTR2594 (Netherlands Trial Register).

Cited by 55 publications

References 53 publications

Systematic scoping review of enhanced recovery protocol recommendations targeting return of gastrointestinal function after colorectal surgery

Systematic scoping review of enhanced recovery protocol recommendations targeting return of gastrointestinal function after colorectal surgery

This month on Twitter

Real‐time bowel sound analysis using newly developed device in patients undergoing gastric surgery for gastric tumor

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