Review: chewing gum after abdominal surgery reduces time to return of bowel function but not length of hospital stay
P P Tekkis
Dr P P Tekkis, St Mary’s Hospital, London, UK;
Does chewing gum after colectomy reduce time to return to normal bowel function and length of hospital stay after surgery?
Studies selected compared use of chewing gum with no chewing gum in the early period after surgery in patients who had colectomy, reported ⩾1 outcome of interest, and clearly reported reasons for surgery and whether chewing gum was used. Trials were excluded if outcomes were not clearly reported for both groups, relevant data could not be extracted or calculated, or there was considerable overlap of authors, centres, or patient cohorts with other studies. Outcomes were return to normal bowel function (time to first flatus or bowel movement after surgery) and length of hospital stay after surgery.
Medline, EMBASE/Excerpta Medica, Ovid, and Cochrane databases (all to Jul 2008), and reference lists were searched for randomised controlled trials (RCTs). 5 RCTs (n = 158, mean age 56–68 y, 59% men) met the selection criteria: 4 involved open surgery and 1 laparoscopic surgery, and each trial used sugarless gum that was chewed 3 times/day after surgery for 5–45 minutes. Quality assessment of individual studies was based on the Jadad scale; 3 RCTs had scores ⩾3 out of 5.
Meta-analysis showed that chewing gum after colectomy reduced time to first flatus and first bowel movement but not length of hospital stay after surgery (table).
In patients having abdominal surgery, chewing gum after surgery reduces time to first flatus and first bowel movement but not length of hospital stay.
Purkayastha S, Tilney HS, Darzi AW, et al. Meta-analysis of randomized studies evaluating chewing gum to enhance postoperative recovery following colectomy. Arch Surg 2008;143:788–93.
Clinical impact ratings: Perioperative 6/7; General surgery 6/7; Gastrointestinal/colorectal surgery 6/7
There is much interest in enhancing bowel function and recovery after abdominal surgery and potentially decreasing length of hospital stay.1 Purkayastha et al report results of a meta-analysis of randomised trials evaluating the effect of chewing gum on return to normal bowel function after colectomy. They found a decrease in time to first flatus and bowel movement; however, the decrease in length of hospital stay was not statistically significant. Since time to return to normal bowel function (first flatus or bowel movement) often determines length of hospital stay, one would also expect to see a significant decrease in the latter outcome. Only 4 of 5 trials measured length of hospital stay, and although the observed reduction was not statistically significant, such a difference would be clinically important; more research is needed. Any decrease in length of hospital stay could benefit both patients and institutions.
The methodology of the meta-analysis was thorough and clearly explained. Of note, only 5 RCTs, with a total of 158 patients, met inclusion criteria. Variation existed among the studies: 4 involved open procedures and 1 a laparoscopic procedure, 2 studies allowed oral fluids before passage of flatus, and stoma formation was not mentioned in 3 studies. All studies had patients chew sugarless gum 3 times/day for 5–45 minutes.
Interventions that can decrease length of hospital stay are greatly desired in today’s healthcare environment. This meta-analysis presents a simple, inexpensive solution to a common problem, with no related adverse events. Use of chewing gum may also provide an alternative, or even interim step, to the introduction of early feeding regimens after surgery. In addition, this simple intervention can provide comfort to patients, an important consideration for hospitals seeking ways to increase patient satisfaction. Further research with larger samples is recommended.