Use of Chewing Gum in Reducing Postoperative Ileus After Elective Colorectal Resection: A Systematic Review

Chan, Miranda K. Y.; Law, Wai Lun

doi:10.1007/s10350-007-9039-9

Cited by 106 publications

(68 citation statements)

References 37 publications

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“…Although it may be that laparoscopic surgery leads to decreased length of hospital stay even in the setting of an ERAS program other explanations for the association seen in this study include unmeasured differences in the perioperative care patients may have Good evidence for other interventions that could contribute to an accelerated recovery and shortened length of stay may have been missed in this study. Interventions for which there is sufficient evidence in the form of randomized, controlled trials that were not evaluated include gum chewing and use of IV lidocaine [14][15][16]. Gum chewing has been found to speed the return of gut function, and intraoperative lidocaine has been shown to decrease postoperative pain.…”

Section: Discussionmentioning

confidence: 98%

Adoption of enhanced recovery after surgery (ERAS) strategies for colorectal surgery at academic teaching hospitals and impact on total length of hospital stay

et al. 2011

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Section: Discussionmentioning

confidence: 98%

Adoption of enhanced recovery after surgery (ERAS) strategies for colorectal surgery at academic teaching hospitals and impact on total length of hospital stay

et al. 2011

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“…No limitation based on language and publication status Three meta-analyses 15,16,18 limited the publication language to English. The remaining two meta-analyses 19,22 restricted the written language to English and Chinese.…”

Section: Search Methodologymentioning

confidence: 99%

“…The remaining two meta-analyses 19,22 restricted the written language to English and Chinese. Three meta-analyses 15,16,20 were limited to human subjects.…”

Section: Search Methodologymentioning

confidence: 99%

“…Most of the meta-analyses 15,16,18,19,21e23 were performed with Review Manager statistical software to pool data. The meta-analysis conducted by Chan and colleagues 15 also followed the Quality of Reporting of Meta-analysis (QUOROM) guidelines. Only one meta-analysis 17 was implemented using the Comprehensive Meta-analysis (Biostat, Engelwood, CA, USA) software package.…”

Section: Methodological Qualitymentioning

confidence: 99%

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Chewing gum for postoperative ileus after colorectal surgery: A systematic review of overlapping meta-analyses

Zhang¹,

Deng²,

Shuai³

et al. 2017

Chinese Nursing Research

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a b s t r a c tBackground: Many meta-analyses investigating gum chewing for postoperative recovery after colorectal surgery have been published with inconsistent findings. Therefore, we performed this study to systematically review these overlapping meta-analyses and offer clinical recommendations based on the current best evidence for decision makers. Methods: Multiple databases, including PubMed, EMBASE, Cochrane Library, Chinese BioMedical Literature on disc (CBMdisc), China National Knowledge Infrastructure (CNKI), Chinese Wanfang and Chinese VIP, were searched through October 2016. We included meta-analyses investigating the effectiveness of chewing gum for postoperative ileus after colorectal resection. Two investigators independently scanned and evaluated eligible meta-analyses, extracted essential information, assessed the methodological quality with the Assessment of Multiple Systematic Reviews (AMSTAR) tool and Oxford Levels of Evidence, and used the Jadad decision algorithm at each step for all procedures. Heterogeneity 50% was accepted. Results: Ten meta-analyses were included in our study. The AMSTAR scores varied from 5 to 9, with a median of 7.7. Most heterogeneity fell into the acceptable range. After implementing the Jadad decision algorithm, two meta-analyses of RCTs were selected based on search strategies and the implications of selection. The available best evidence indicated that gum chewing significantly reduced time to first flatus, time to first bowel movement, time to first bowel sounds and length of hospital stay. However, these two meta-analyses reached inconsistent conclusions as to the complications and economic benefits. Conclusions: With the current best available evidence, we suggest gum chewing is beneficial for gastrointestinal function and reducing postoperative ileus.

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“…The development of an ileus was a frequent occurrence and TPN used for most of the patients. A literature review was undertaken to investigate the hypothesis that chewing gum accelerates intestinal transit recovery (1,2,3,4,5) , and has a stress relieving potential which may influence pain control (6,7) . A change in clinical practice was agreed with the urology team.…”

mentioning

confidence: 99%

The benefits of chewing gum in patients undergoing Ileocystoplasty

Capel

2011

Proc. Nutr. Soc.

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Ileocystoplasty is a surgical procedure involving utilisation of the ileum to reconstruct the bladder creating a capacious compliant low pressure structure. Patients often present with pre-existing complex co-morbidities; and prior to surgery their gastric motility is hampered by limited ambulation with the majority being wheelchair dependant. The physical manipulation of the bowel during the ileocystoplasty procedure can trigger a post operative ileus; a multifactorial inflammatory condition resulting in reduced gut transit time. This is compounded by anaesthesia and the use of opiod pain relief.Following surgery the patients referred to the dietitian were repeatedly found to be slow to recover due to distressing symptoms preventing them from re-establishing eating at an early stage. The development of an ileus was a frequent occurrence and TPN used for most of the patients. A literature review was undertaken to investigate the hypothesis that chewing gum accelerates intestinal transit recovery (1,2,3,4,5) , and has a stress relieving potential which may influence pain control (6,7) . A change in clinical practice was agreed with the urology team. Although not a definitive cure for early resolution of an ileus and improved gut transit time the literature indicated this was a safe procedure (8,9) . The main objectives were to improve patient symptoms post surgery, enabling them to re-establish eating and drinking earlier, avoid the need for TPN, enhance the post operative experience and subsequent recovery. All the patients admitted for elective ileocystoplasty surgery from November 2009 to March 2011 were included in this study. Referral to the dietitian was made on or before admission by the clinical nurse specialist. Patients were encouraged to chew sugar free chewing gum as soon as possible post surgery, provided they were safe to do so and there was minimal risk of aspiration. They were encouraged to chew for at least 30 minutes, three times a day until eating was established and their bowels had opened. Patients were asked by the clinical nurse specialist to supply the gum themselves and a variety of types were used. Records were maintained by the dietitian of the symptoms experienced post surgery, the time lapse before eating was re-established, the necessity for TPN, the initial response time and number of contacts made by the dietitian and the duration of their hospital stay. A retrospective review of the previous five years of patient dietetic records was under taken comparing the outcomes for patients who had undergone this procedure.

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Use of Chewing Gum in Reducing Postoperative Ileus After Elective Colorectal Resection: A Systematic Review

Abstract: The use of gum chewing in the postoperative period is a safe method to stimulate bowel motility and reduce ileus after colorectal surgery.

Cited by 106 publications

References 37 publications

Adoption of enhanced recovery after surgery (ERAS) strategies for colorectal surgery at academic teaching hospitals and impact on total length of hospital stay

Adoption of enhanced recovery after surgery (ERAS) strategies for colorectal surgery at academic teaching hospitals and impact on total length of hospital stay

Chewing gum for postoperative ileus after colorectal surgery: A systematic review of overlapping meta-analyses

The benefits of chewing gum in patients undergoing Ileocystoplasty

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