Systematic Review and Meta-Analysis of Chewing-Gum Therapy in the Reduction of Postoperative Paralytic Ileus Following Gastrointestinal Surgery
- First Online:
- 1.8k Downloads
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.
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).
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.
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.
- 2.Salvador C, Sikirica M, Evans A et al (2005) Clinical and economic outcomes of prolonged postoperative ileus in patients undergoing hysterectomy and hemicolectomy. Pharm Ther (P&T) 30:590–595Google Scholar
- 16.Schluender S, Gurland B, Divino C et al (2005) Gum chewing does not enhance the return of bowel function in patients undergoing elective colon resection in a randomized blinded pilot study. Colorectal Dis 92(Suppl 1):P143Google Scholar
- 20.Higgins J, Green S (2006) Cochrane handbook for systematic reviews of intervention, version 4.2.6, 4th edn. Cochrane Collaboration Secretariat, Oxford, UKGoogle Scholar
- 30.Traut U, Brugger L, Kunz R et al (2008) Systemic prokinetic pharmacologic treatment for postoperative adynamic ileus following abdominal surgery in adults. Cochrane Database Syst Rev (Online) 1:CD004930Google Scholar
- 35.Reisine T, Pasternak G (1996) Opioid analgesics and antagonists. In: Hardman J, Limbird L (eds) Goodman & Gilman’s the pharmacological basis of therapeutics. McGraw-Hill, New YorkGoogle Scholar