World Journal of Surgery

, Volume 33, Issue 12, pp 2557–2566

Systematic Review and Meta-Analysis of Chewing-Gum Therapy in the Reduction of Postoperative Paralytic Ileus Following Gastrointestinal Surgery

Article

DOI: 10.1007/s00268-009-0104-5

Cite this article as:
Fitzgerald, J.E.F. & Ahmed, I. World J Surg (2009) 33: 2557. doi:10.1007/s00268-009-0104-5

Abstract

Background

Postoperative ileus has long been considered an inevitable consequence of gastrointestinal surgery. It prolongs hospital stay, increases morbidity, and adds to treatment costs. Chewing is a form of sham feeding reported to stimulate bowel motility. This analysis examines the value of chewing-gum therapy in treatment of postoperative ileus.

Methods

A search for randomized, controlled trials studying elective gastrointestinal surgery was undertaken using MEDLINE, Embase, Cochrane Controlled Trials Register, and reference lists. Outcomes were extracted including time to first flatus and bowel motion, length of stay, and complications. Statistical analysis was undertaken using the weighted mean difference (WMD) and random-effects model with 95% confidence intervals (CI).

Results

Seven studies with 272 patients were included. For time to first flatus the analysis favored treatment with a WMD of 12.6 h (17%) reduction (95% CI −21.49 to −3.72; P = 0.005). For time to first bowel motion, treatment was favored with a WMD of 23.11 h (22%) reduction (95% CI −34.32 to −11.91; P < 0.001). For length of stay, the analysis showed a nonsignificant trend toward treatment with WMD of 23.88 h (12%) reduction (95% CI −53.29 to +5.53; P = 0.11). There were no significant differences in complication rates.

Conclusions

Chewing-gum therapy following open gastrointestinal surgery is beneficial in reducing the period of postoperative ileus, although without a significant reduction in length of hospital stay. These outcomes are not significant for laparoscopic gastrointestinal surgery.

Supplementary material

268_2009_104_MOESM1_ESM.doc (32 kb)
Supplementary material 1 (DOC 32 kb)
268_2009_104_MOESM2_ESM.doc (41 kb)
Supplementary material 2 (DOC 41 kb)

Copyright information

© Société Internationale de Chirurgie 2009

Authors and Affiliations

  1. 1.Department of Gastrointestinal Surgery, Queen’s Medical CentreNottingham University Hospitals NHS TrustNottinghamUK
  2. 2.Department of SurgeryAberdeen Royal InfirmaryAberdeenScotland
  3. 3.Medical Education UnitUniversity of Nottingham Medical School, Queens Medical CentreNottinghamUK