Role Of Caffeine As A Bowel Stimulant After Major Gynecological Surgeries

To investigate the effect of postoperative gum chewing on bowel motility after laparoscopic gynecologic surgery. In this randomized controlled trial, patients were allocated to either postoperative gum chewing every 2 hours for 15 minutes or standard postoperative care without gum chewing. The study's primary end points were time to first regular bowel sounds and time to first passage of flatus after surgery. Secondary end points were time of operation to first defecation, patient satisfaction concerning postoperative gum chewing, potential side effects of postoperative gum chewing, and potential effect of gum chewing on postoperative pain therapy. One hundred seventy-nine patients were included in this trial. We found a significantly shorter interval between surgery and passage of first flatus in the intervention group compared with the control group (median 6.2 hours compared with 8.1 hours; P=.002) and a significantly higher rate of regular bowel sounds 3 hours (76% compared with 47%; P<.001) and 5 hours (91% compared with 78%; P=.01) after surgery. Fewer opioid analgetics were administered to patients allocated to the intervention group (P=.02). There was no significant difference in time to first defecation between groups (median 26.3 hours compared with 29.0 hours, P=.165). Gum chewing was well tolerated and well accepted by patients, and no intervention-related side effects were observed. Gum chewing seems to have beneficial effects on bowel motility when used as an adjunct treatment in postoperative care after minimally invasive surgery. Gum chewing should be recommended to patients after gynecologic laparoscopic surgery. www.ClinicalTrials.gov, NCT 01549353. I.

Chewing gum for enhancing early recovery of bowel function after caesarean section.

To evaluate whether coffee consumption accelerates the recovery of bowel function after cesarean section or not. This study was designed as randomized controlled study. Patients were randomly assigned to one of two groups: Ultimately, Group 1 (n = 51) was the study group and drank three cups of coffee after cesarean, whereas group 2 (n = 52) was not given any treatment. The primary outcome measure was the time to first defecation after surgery, the secondary outcomes were time to first bowel movement, passage of flatus, time to toleration of a solid diet, additional antiemetic and analgesic requirement. There were no significant differences in demographic variables between the groups. The mean time to passage of first flatus was significantly shorter in the study group than the control group (8.6 ± 3.3 h vs 11.3 ± 7.5 h, respectively; p = 0.022). First defecation was 20.7 ± 11.5 h for the study group and at 29.1 ± 14.3 h for the control group (p = 0.001). In addition, there was a significant difference in mean time to toleration of solid food between the study and control groups (8.78 ± 2.33 h vs 12.88 ± 4.2.60 h, respectively; p < 0.001). Coffee can be used in patients to enhance the recovery of gastrointestinal function after elective cesarean section.

IntroductionColorectal cancer is classified as the second most prevalent type of cancer among males and females in Jordan; approximately 1260 (10.9%) out of 11559 cases were diagnosed with colorectal cancer in 2020. According to American statistics, colorectal cancer is the third leading cause of cancer-related deaths among both males and females, as well as the second leading cause when combining both numbers .ObjectiveThe current study aimed to assess the effectiveness of chewing gum in reducing postoperative ileus in patients with cancer after colorectal surgeries and evaluate the length of hospital stay (LOS) after colorectal resection, complications, and costs.MethodsOne-hundred twenty-nine patients who underwent colorectal surgeries at a specialized cancer center in Jordan from April 2019 to May 2020 were recruited. After colorectal surgeries, patients were randomized into two groups. The control group (69 patients) received conventional postoperative care; the experimental group (60 patients) was asked to chew free sugar gum over one hour in the morning, noon, and evening until the first flatus.ResultThe passage of the first flatus was significantly shorter in the experimental group (mean 48.02 h) than in the control group (116.45); p = .001. Also, there was a significant difference between both groups according to gender and age.ConclusionChewing free sugar gum after colorectal surgeries can significantly improve the recovery of bowel motion by accelerating the time to first auscultation to bowel sounds, the first passage of flatus, and reduction in the LOS, which went in agreement with many studies. However, chewing gum is considered a safe, cheap, and practical method to reduce ileus.

Effect of gum chewing on the return of bowel sounds, time to first flatus, and defecation after colorectal cancer surgery: A prospective, randomized controlled trial.

Post-operative ileus is a common compliant of patients at surgical floor. Studies have reported that gums chewing after abdominal surgeries decrease postoperative ileus (POI); but very few studies are available on role of chewing gum in ileostomy reversal cases. We concluded that post-operative gum chewing with standard post-operative care in patients undergoing elective surgery for ileostomy closure done for typhoid ileal perforation in terms of mean length of hospital stay and mean time of passage of first flatus is significantly better than those without gum chewing. Objectives: To compare post-operative gum chewing with standard care in cases having elective ileostomy closure in terms of mean length of hospital stay and mean time of passage of first flatus. Study Design: Randomized Control Trial. Setting: Department of Surgery, Allied Hospital Faisalabad. Period: 1st January 2017 to 31st December 2017. Material &amp; Methods: Patients of 20 to 60 years undergoing elective surgery for typhoid ileal perforation were included in the study after informed consent. Two groups with A: allocated to chewing gum three times a day up to discharge; Control group: allocated to standard post-operative care without chew gum. Length of hospital stay and time of passage of first flatus was noted. Results: In this study, mean length of hospital stay in Chewing gum group was 7.73+0.74 days and 10.27+0.87 days in Control group, p value was 0.0001, mean time of passage of first flatus in Chewing gum group was 49.97+1.69 hrs and 89.17+2.07 hrs in Control group, p value was 0.0001. Conclusion: We concluded that post-operative gum chewing with standard post-operative care in patients undergoing elective surgery for ileostomy closure done for typhoid ileal perforation in terms of mean length of hospital stay and mean time of passage of first flatus is significantly better than those without gum chewing.

Coffee consumption for recovery of intestinal function after laparoscopic gynecological surgery: A randomized controlled trial.

Postoperative ileus limits early hospital discharge for patients who have undergone laparoscopic procedures. Sham feeding has been reported to enhance bowel motility. Here, the effect of gum chewing is evaluated as a convenient method to enhance postoperative recovery from ileus after laparoscopic colectomy. A total of 19 patients who underwent elective laparoscopic colectomy for colorectal cancer participated in the study. Each patient was randomly assigned to one of two groups: a gum-chewing group (n = 10, mean age 58.6 years, range 50 to 71 years) or a control group (n = 9, mean age 60.6 years, range 45 to 80 years). The patients in the gum-chewing group chewed gum three times a day from the first postoperative AM until oral intake. The times of the first passage of flatus and defecation were recorded precisely. The first passage of flatus was seen, on average, on postoperative day 2.1 in the gum-chewing group and on day 3.2 in the control group (p < 0.01). The first defecation was 2.7 days sooner in the gum-chewing group (postoperative day 3.1) than in the control group (5.8 days; p< 0.01). All patients tolerated gum chewing on the first operative AM. The postoperative hospital stays for the gum-chewing and control groups were 13.5+/-3.0 days and 14.5+/-6.1 days, respectively. Gum chewing aids early recovery from postoperative ileus and is an inexpensive and physiologic method for stimulating bowel motility. Gum chewing should be added as an adjunct treatment in postoperative care because it might contribute to shorter hospital stays.

Short-Term Effects of Connective Tissue Massage After Hysterectomy: A Randomized Controlled Study

To determine the effects of chewing gum, early oral hydration and early mobilisation on the time of first bowel sounds, first passage of flatus and first defecation following abdominal gynaecologic surgery. A major complication of abdominal surgical procedures is paralytic ileus which results in patient discomfort, prolonged length of hospital stay and increased cost of treatment. Prospective randomised case-control study. Women who underwent abdominal gynaecological surgery for benign disorders under general anaesthesia were randomised into eight groups according to different combinations of interventions consisting of chewing gum, early oral hydration and early mobilisation. The effects of these interventions on the time of first bowel sounds, first passage of flatus and first defecation following abdominal gynaecologic surgery were investigated. The data were analysed using chi-square tests, t-test for independent samples, Tukey's HSD test, pairwise comparison test, one-way analysis of variance. It was found that the time when bowel sounds were heard was shorter, the time first passage of flatus was shorter and first defecation occurred earlier in the 1st group of women who chew gum, were hydrated orally and were mobilised early after surgery than the other groups. It was also determined that these periods were longest in the women who did not receive any intervention and received the routine hospital care when compared with other groups. Duration of hospital stay was shorter in the women who chew gum, were hydrated orally and were mobilised early than the other groups. Early oral feeding, early mobilisation and chewing gum are effective methods in terms of preventing paralytic ileus following abdominal gynaecological surgery, improving patient comfort and shortening the duration of hospitalisation. Nurses may cause early recovery, improve the patient comfort, prevent paralytic ileus and shorten the duration of hospitalisation after gynaecologic abdominal surgery by recommending gum chewing, early mobilisation and early hydration.

To evaluate the effects of gum chewing combined with a semi-liquid diet on patients after gynaecologic laparoscopic surgery. Previous studies suggested that chewing gum before traditional postoperative care promotes the postoperative recovery of bowel motility and function after open and laparoscopic surgery. However, gum chewing combined with a semi-liquid diet has not been reported in postoperative care of patients following gynaecologic laparoscopic surgery. A prospective randomised study. Total 234 patients were randomly assigned after elective gynaecologic laparoscopic surgery to a gum chewing and semi-liquid diet group, a semi-liquid only diet group or a liquid diet group. The gum chewing and semi-liquid diet group chewed sugar-free gum with an oral intake of a semi-liquid diet six hours postoperatively. The semi-liquid only diet and liquid diet groups received a semi-liquid diet or a liquid diet, respectively. The time to first bowel sounds, time to first regular postoperative bowel sounds, time to first passage of flatus, time to first defecation, serum gastrin and incidences of hunger, nausea, vomiting and abdominal distension were recorded. Hunger and gastrointestinal sensations were assessed using a four-point scale. Serum gastrin was assayed pre- and postoperatively using a gastrin radioimmunoassay kit. The gum chewing and semi-liquid diet group had first bowel sounds, first regular bowel sounds, first passage of flatus and first defecation earlier than the semi-liquid only and liquid groups. Increased serum gastrin was observed in the gum chewing and semi-liquid diet group. Incidences of nausea, vomiting and abdominal distention were not significantly different between these groups. Chewing gum combined with an oral intake of a semi-liquid diet is safe and accelerates the postoperative recovery of bowel function. It might be recommended as a better postoperative care regimen for patients after gynaecologic laparoscopic surgery. This study developed a new postoperative diet regimen to improve the postoperative care of patients undergoing laparoscopic gynecologic surgery.

To explore and evaluate the safety and efficacy of early oral intake following major abdominal gynecological oncology surgery. During an 11-month period, 60 gynecological oncology patients undergoing major intra-abdominal surgery were enrolled in a randomized controlled clinical trial of semiliquid diet (experimental group) compared with clear feeds (control group) 6 hours after operation. Patients were evaluated for nausea, vomiting, bowel sound, passage of flatus, body weight difference before and after operation, urine acetone, fasting blood sugar, and prealbumin level, and need for nasogastric tube decompression. There were significantly higher incidences of nausea, shorter time of regular diet resumption, and higher level of prealbumin on postoperative day 7 in patients from the experimental group than those from the control group (P < .05). No significant differences were found in vomiting, the time to development of bowel sound and passage of flatus, body weight difference before and after operation, urine acetone and fasting blood sugar on postoperative day 1, and prealbumin level on postoperative day 2 between the 2 groups. Early oral intake with semiliquid diet 6 hours after major intra-abdominal gynecological oncology surgery is safe and well tolerated.

Postoperative ileus is a common concern following cesarean section, leading to delayed gastrointestinal recovery. Chewing gum has emerged as a simple and non-invasive intervention to enhance bowel motility through the cephalic vagal reflex and stimulation of gastrointestinal hormone secretion, thereby promoting the early return of bowel sounds and passage of flatus. Objective: This study aimed to compare the mean postoperative time interval for the return of bowel sounds and the first passage of flatus between women who chewed gum and those who did not following a cesarean section. Methods: A prospective, randomised controlled trial was conducted at the Department of Obstetrics and Gynecology, Bahawalpur Victoria Hospital, Bahawalpur, over six months after ethical approval from October 2020 to March 2021. A total of 60 women aged 18 to 40 years undergoing elective cesarean section were included. Patients with electrolyte imbalances, diabetes, or prior intra-abdominal surgery were excluded. Participants were randomly allocated into two groups: Group A (gum chewing) and Group B (non-gum chewing). Women in Group A received one stick (5 grams) of chewing gum three times a day for one hour, starting six hours postoperatively. In contrast, Group B received standard postoperative care without gum chewing. The primary outcomes were the mean time to the first auscultation of normal bowel sounds and the first passage of flatus. Results: The mean age of patients in Group A was 30.20 ± 4.24 years, and in Group B, it was 29.87 ± 4.28 years. The mean time to the return of bowel sounds in Group A was significantly shorter (10.60 ± 1.90 hours) compared to Group B (16.03 ± 2.63 hours) (p &lt; 0.0001). Similarly, the mean time to the first passage of flatus was significantly reduced in Group A (18.67 ± 2.38 hours) compared to Group B (25.63 ± 2.89 hours) (p &lt; 0.0001). Conclusion: Chewing gum significantly reduces the time to the return of bowel sounds and the first passage of flatus following cesarean section, suggesting its effectiveness as a simple and safe intervention to enhance postoperative gastrointestinal recovery.

One important factor affecting early recovery in patients undergoing open complete staging surgery for gynecological malignancies is the return of normal bowel function. Gum chewing is a simple and inexpensive intervention that facilitates early recovery of bowel function in patients undergoing several types of gastrointestinal surgery. No previous study has investigated the possible favorable effects of gum chewing on return of bowel function in patients undergoing elective total abdominal hysterectomy and systematic retroperitoneal lymphadenectomy. This randomized controlled trial was designed to assess the effectiveness of gum chewing for return of postoperative bowel function in patients undergoing abdominal complete staging surgery for gynecological malignancies. Participants were women undergoing abdominal complete surgical staging for various gynecological cancers. A total of 149 patients were randomized to a gum-chewing group (n = 74) or a control group (n = 75) who received no treatment. Gum chewing began on the first postoperative day. Patients chewed sugar-free gum 3 times daily until the first passage of flatus. Each session of chewing lasted 30 minutes. All patients underwent total abdominal hysterectomy and had systematic pelvic and para-aortic lymph node dissection as part of complete staging surgery. Postoperative outcome measures included time to first bowel movement, time to passage of first flatus and feces, time to tolerate oral feeding, need for antiemetics and analgesics, mild ileus rate, and length of hospital stay. There was significant improvement in the gum-chewing group compared with the control group for the following outcomes: mean time to bowel movement (41.5 ± 15.7 vs 50.1 ± 15.9 hours; P < 0.001), mean time to flatus (34.0 ± 11.5 vs 43.6 ± 14.0 hours; P < 0.001), mean time to defecation (49.6 ± 18.7 vs 62.5 ± 21.5 hours; P < 0.001), mean time to tolerate diet (4.0 ± 0.8 vs 5.0 ± 0.9 days; P < 0.001), and mean length of hospital stay (5.9 ± 1 vs 7.0 ± 1.4 days; P < 0.001). Mild ileus symptoms occurred in 27 patients (36%) in the control group and 11 patients (14.9%) in the gum-chewing group; the relative risk was 2.4 with a 95% confidence interval of 1.2 to 4.5; P = 0.004. Two patients (27%) in the control group had severe ileus symptoms. There were no adverse effects in the gum-chewing group. These data show that use of gum chewing early in the postoperative period following elective total abdominal hysterectomy and systematic retroperitoneal lymphadenectomy hastens time to bowel recovery. Gum chewing reduced time to the first flatus and defecation, time to first bowel movement, and time to tolerate oral feedings. The investigators believe that this inexpensive and well-tolerated intervention should be added as an adjunct treatment in postoperative care of patients in this population.

BackgroundAcetylcholinesterase inhibitors (e.g., pyridostigmine bromide) are used for neuromuscular blockade (NMB) reversal in patients undergoing surgery under general anesthesia (GA). Concurrent use of anticholinergic agents (e.g., glycopyrrolate) decreases cholinergic side effects but can impede bowel movements. Sugammadex has no cholinergic effects; its use modifies recovery of gastrointestinal (GI) motility following laparoscopic cholecystectomy compared to pyridostigmine/glycopyrrolate. This study evaluated the contribution of sugammadex to the recovery of GI motility compared with pyridostigmine and glycopyrrolate.MethodsWe conducted a prospective study of patients who underwent laparoscopic cholecystectomy. Patients were randomly allocated to the experimental group (sugammadex, Group S) or control group (pyridostigmine-glycopyrrolate, Group P). After anesthesia (propofol and rocuronium, and 2% sevoflurane), recovery was induced by injection of sugammadex or a pyridostigmine-glycopyrrolate mixture. As a primary outcome, patients recorded the time of their first passage of flatus (‘gas-out time’) and defecation. The secondary outcome was stool types.ResultsOne-hundred and two patients participated (Group S [n = 49], Group P [n = 53]). Mean time from injection of NMB reversal agents to gas-out time was 15.03 (6.36–20.25) h in Group S and 20.85 (16.34–25.86) h in Group P (P = 0.001). Inter-group differences were significant. Time until the first defecation as well as types of stools was not significantly different.ConclusionsSugammadex after laparoscopic cholecystectomy under GA resulted in an earlier first postoperative passage of flatus compared with the use of a mixture of pyridostigmine and glycopyrrolate. These findings suggest that the use of sugammadex has positive effects on the recovery of GI motility.