Randomized clinical trial of the effect of gum chewing on postoperative ileus and inflammation in colorectal surgery

Heijkant, T. C. van den; Costes, L M M; Lee, D. G. C. van der; Aerts, Bart; Jong, Margreet Osinga-de; Rutten, H.; Hulsewé, Karel W. E.; Jonge, Wouter J. de; Buurman, Wim A.; Luyer, Misha

doi:10.1002/bjs.9691

Cited by 88 publications

(97 citation statements)

References 38 publications

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“…Only two of 565 patients in the entire population (0.35%) died within 90 days after surgery, and none of the deaths was attributed to the intervention (chewing gum). These findings are consistent with similar reports showing the safety of SMD, acupuncture and chewing gum after surgery125212223. We conclude that SMD, acupuncture, and chewing gum do not significantly affect risk of incidence or type of complications.…”

Section: Discussionsupporting

confidence: 92%

“…First, the study population of 590 patients, recruited over two years, is larger than in similar RCTs in the literature. Second, the study population included only patients with colorectal cancer with no history of abdominal surgery, making it more homogeneous than the populations in previous trials that included patients with various types of colorectal disease22223 or with a history of abdominal surgery2. Third, in part because of our large sample, we were able to perform subgroup analysis based on open or laparoscopic resection.…”

Section: Discussionmentioning

confidence: 99%

“…Though most patients undergoing colorectal resection recover bowel movements within a week, some suffer prolonged intestinal paralysis or postoperative ileus (POI), reducing comfort, increasing morbidity and mortality, and extending hospitalization, all of which increase healthcare costs123. This highlights the importance of preventing POI234.…”

mentioning

confidence: 99%

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

Yang

Zuo

Zhao

et al. 2017

Sci Rep

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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).

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

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

Yang

Zuo

Zhao

et al. 2017

Sci Rep

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“…Of which 17 [21, 22, 24–26, 28–39] recruited the patients undergoing open colorectal surgery, 7 [7, 20, 23, 27, 41–43] performed hybrid surgery approaches (open and laparoscopic), and 2 [19, 40] conducted laparoscopic surgery. Of these 26 studies, it is noted that, 3 [41–43] were conference abstract, and the corresponding information were extracted from the Cochrane systematic review published by Short et al [14].…”

Section: Resultsmentioning

confidence: 99%

Meta-analysis comparing chewing gum versus standard postoperative care after colorectal resection

et al. 2016

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BackgroundPrevious incomplete studies investigating the potential of chewing gum (CG) in patients undergoing colorectal resection did not obtain definitive conclusions. This updated meta-analysis was therefore conducted to evaluate the effect and safety of CG versus standard postoperative care protocols (SPCPs) after colorectal surgery.ResultsTotal 26 RCTs enrolling 2214 patients were included in this study. The CG can be well-tolerated by all patients. Compared with SPCPs, CG was associated with shorter time to first flatus (weighted mean difference (WMD) −12.14 (95 per cent c.i. −15.71 to −8.56) hours; P < 0.001), bowl movement (WMD −17.32 (−23.41 to −11.22) hours; P < 0.001), bowel sounds (WMD −6.02 (−7.42 to −4.63) hours; P < 0.001), and length of hospital stay (WMD −0.95 (−1.55 to −0.35) days; P < 0.001), a lower risk of postoperative ileus (risk ratio (RR) 0.61 (0.44 to 0.83); P = 0.002), net beneficial and quality of life. There were no significant differences between the two groups in overall complications, nausea, vomiting, bloating, wound infection, bleeding, dehiscence, readmission, reoperation, mortality.Materials and MethodsThe potentially eligible randomized controlled trials (RCTs) that compared CG with SPCPs for colorectal resection were searched in PubMed, Embase, Cochrane library, China National Knowledge Infrastructure (CNKI), and Chinese Wanfang databases through May 2016. The trial sequential analysis was adopted to examine whether a firm conclusion for specific outcome can be drawn.ConclusionsCG is benefit for enhancing return of gastrointestinal function after colorectal resection, and may be associated with lower risk of postoperative ileus.

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“…Une réalimentation précoce dès le réveil est encouragée et permet de réduire la durée de séjour et les complications, sans augmenter le risque de lâchage d'anastomose [28]. Cependant une réalimentation précoce peut engendrer plus de vomissements si elle n'est pas accompagnée d'une pré-vention systématique des nausées et vomissements postopé-ratoires ainsi qu'une prise en charge multimodale de l'iléus paralytique en stimulant la mobilisation précoce, en rédui-sant les apports hydriques intraveineux et en employant des laxatifs oraux et/ou des gommes à mâcher [29].…”

Section: Introductionunclassified

ERAS® et la réhabilitation précoce en chirurgie colorectale

Roulin

Demartines

2015

Colon Rectum

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La réhabilitation précoce en chirurgie, ou Enhanced Recovery After Surgery (ERAS ® ), est une prise en charge multidisciplinaire, standardisée, et basée sur la médecine factuelle. L'application de ses principes permet de diminuer significativement les complications postopé-ratoires avec pour conséquence une diminution de la durée d'hospitalisation et des coûts de la santé. L'évolu-tion postopératoire est étroitement liée à l'adhérence aux différents éléments composant un programme de réhabi-litation précoce. Ainsi l'emploi d'un outil d'audit prospectif est essentiel afin de garantir une prise en charge optimale des patients. Mots clés Réhabilitation précoce · ERAS · Chirurgie colorectaleAbstract Enhanced recovery after surgery (ERAS ® ) is a multimodal, standardized and evidence-based perioperative care pathway. With ERAS ® , postoperative complications are significantly lowered, and, as a secondary effect, length of hospital stay and health cost is reduced. Postoperative outcome is related to the compliance to the components of the enhanced recovery programme. Therefore, a prospective audit tool is essential in order to ensure an optimal management of the patient.

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Randomized clinical trial of the effect of gum chewing on postoperative ileus and inflammation in colorectal surgery

Abstract: NTR2867 (http://www.trialregister.nl).

Cited by 88 publications

References 38 publications

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

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

Meta-analysis comparing chewing gum versus standard postoperative care after colorectal resection

ERAS® et la réhabilitation précoce en chirurgie colorectale

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