Perioperative use of chewing gum affects the inflammatory response and reduces postoperative ileus following major colorectal surgery

Su’a, Bruce; Hill, Andrew G.

doi:10.1136/ebmed-2015-110190

Cited by 6 publications

(6 citation statements)

References 5 publications

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“…Postoperative ileus (POI) remains a challenging clinical reality affecting up to 25% of the patients [1]. In a recent analysis, prolonged ileus was the postoperative complication associated with the largest increase in length of stay [2].…”

Section: Introductionmentioning

confidence: 99%

Postoperative ileus in an enhanced recovery pathway—a retrospective cohort study

Grass

Slieker

Jurt

et al. 2017

Int J Colorectal Dis

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Section: Introductionmentioning

confidence: 99%

Postoperative ileus in an enhanced recovery pathway—a retrospective cohort study

Grass

Slieker

Jurt

et al. 2017

Int J Colorectal Dis

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“…Gum chewing (GC), a kind of sham feeding alternative to early feeding, which is expected to stimulate the cephalic-vagal reflex to increase hormone secretion and then enhance intestinal motility [ 8 ], may produce a positive effect on postoperative ileus by reducing postoperative inflammation [ 9 ]. However, the underlying mechanisms behind the effects of gum chewing works remain elusive and the results of clinical studies to date are inconclusive, and thus chewing gum has not yet been incorporated into the related guidelines or standard pathways for postoperative nursing [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

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

Mei

Wang

Cui

et al. 2017

Gastroenterology Research and Practice

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Background This meta-analysis was performed to assess the efficacy and safety of chewing gum in intestinal function recovery after colorectal cancer surgery. Methods A systematic search was conducted in PubMed, Embase, Science Direct, and Cochrane library for relevant randomized controlled trials (RCTs) published until April 2017. Summary risk ratios or weighted mean differences with 95% confidence intervals were used for continuous and dichotomous outcomes, respectively. Results 17 RCTs with a total number of 1845 patients were included. Gum chewing following colorectal cancer surgery significantly reduced the time to first passage of flatus (WMD −0.55; 95% CI −0.94 to −0.16; P = 0.006), first bowel movement (WMD −0.60; 95% CI −0.87 to −0.33; P < 0.0001), start feeding (WMD −1.32; 95% CI −2.18 to −0.46; P = 0.003), and the length of postoperative hospital stay (WMD −0.88; 95% CI −1.59 to −0.17; P = 0.01), but no obvious differences were found in postoperative nausea, vomiting, abdominal distention, pneumonia, and mortality, which were consistent with the findings of intention to treat analysis. Conclusions Chewing gum could accelerate the recovery of intestinal function after colorectal cancer surgery. However, it confers no advantage in postoperative clinical complications. Further large-scale and high-quality RCTs should be conducted to confirm these results.

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“…On one hand, although the patient accepted EOF at first, surgeons had to reinsert nasogastric tubes and restart tube feeding in response to certain adverse events or according to the patient's requirement. On the other hand, surgeons might apply the strategy of NGT reinsertion once POI has not been resolved within a reasonable period after colorectal surgery, which challenges 25% of the patients ( 26 ). Wolthuis proposed NGT reinsertion as the most significant sign of prolonged POI (despite an overestimation of ileus rates), which affects LOS and postoperative complications ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

Impact of Early Oral Feeding on Nasogastric Tube Reinsertion After Elective Colorectal Surgery: A Systematic Review and Meta-Analysis

Wang

Zhang

et al. 2022

Front. Surg.

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BackgroundColorectal cancer is a common malignant tumor appearing in the gastrointestinal tract. Surgical resection is recognized as the best means to improve patient survival. However, it is controversial whether early oral feeding (EOF) after elective colorectal resection demonstrates safety and efficacy in concerned clinical outcomes.MethodsWe searched PubMed, Embase, Cochrane Library, and CNKI from inception to September 2021. Two authors independently screened the retrieved records and extracted data. EOF was defined as feeding within 24 h after surgery, while traditional oral feeding (TOF) was defined as feeding that started after the gastrointestinal flatus or ileus was resolved. The primary outcome was nasogastric tube insertion, and the secondary outcomes were the length of hospital stay and total complications. Categorical data were combined using odds ratio (OR), and continuous data were combined using mean difference (MD).ResultsWe screened 10 studies from 34 records after full-text reading, with 1,199 patients included in the analysis. Nasogastric tube reinsertion (OR 1.69; 95% CI 1.08 to 2.64, p=0.02) was more frequent in the EOF group, and older ages (>60 years) were associated with higher risk of nasogastric tube reinsertion (OR 2.05; 95% CI 1.05 to 3.99, p = 0.04). Reduced length of hospital stay (MD −1.76; 95% CI −2.32 to −1.21; p < 0.01) and the rate of total complications (OR 0.49; 95% CI 0.37 to 0.65, p < 0.01) were observed in EOF compared with TOF.ConclusionsEOF was safe and effective for patients undergoing elective colorectal surgery, but the higher rate of nasogastric tube reinsertion compared with TOF should not be ignored.

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Perioperative use of chewing gum affects the inflammatory response and reduces postoperative ileus following major colorectal surgery

Cited by 6 publications

References 5 publications

Postoperative ileus in an enhanced recovery pathway—a retrospective cohort study

Postoperative ileus in an enhanced recovery pathway—a retrospective cohort study

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

Impact of Early Oral Feeding on Nasogastric Tube Reinsertion After Elective Colorectal Surgery: A Systematic Review and Meta-Analysis

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