Use of chewing gum in reducing postoperative ileus after elective colorectal resection: A systematic review

Abstract

PURPOSE: Published studies comparing the addition of chewing gum to standardized postoperative care to shorten postoperative ileus showed controversial results. This study was designed to conduct a systematic review of all relevant trials on chewing gum to reduce postoperative ileus after colorectal resection. METHODS: All published trials that compared the additional use of gum chewing with standard postoperative management were identified from Ovid MEDLINE, EMBASE, CINAHL, and All Evidence-Based Medicine Reviews between January 1991 and January 2007. The clinical outcomes were extracted and meta-analysis was performed by Forest plot review. RESULTS: Five randomized, controlled trials with 158 (94 males) patients with mean age of 61.9 years were included. Seventy-eight patients received an addition of gum chewing and 80 had standard postoperative care for colorectal resection. Operating time (P=0.78) and blood loss (P=0.48) were similar. All patients tolerated the gum without any side-effects. With combined standard postoperative care and gum chewing, the patients passed flatus 24.3 percent earlier (weighted mean difference, -20.8 hours; P=0.0006) and had bowel movement 32.7 percent earlier (weighted mean difference, -33.3 hours; P=0.0002). They were discharged 17.6 percent earlier than those having ordinary postoperative treatment (weighted mean difference, -2.4 days; P<0.00001). The gum-chewing group was associated with similar overall postoperative complication rate (odds ratio, 0.45; P=0.05) with individual complication showing a trend favoring gum chewing, although they were not of statistical significance. Readmission (odds ratio, 0.36; P=0.24) and reoperation rates (odds ratio, 1.36; P=0.83) of the two groups were similar. CONCLUSIONS: The use of gum chewing in the postoperative period is a safe method to stimulate bowel motility and reduce ileus after colorectal surgery. © 2007 American Society of Colon and Rectal Surgeons.