The Enhanced Recovery After Surgery (ERAS) for Patients Undergoing Planned Abdomino-Pelvic Surgery: Recovering Bowel Motility and Reducing Length of Stay

Abstract

Objective: To evaluate the effectiveness of chewing gum in improving paralytic ileus, shortening hospital stays, and enhancing satisfaction in patients undergoing planned abdomino-pelvic surgery.
 Methodology: A quasi-experimental study with a non-equivalent groups design was conducted in the Obstetrics and Gynecology department of Rawalpindi Teaching Hospital from January 15, 2023, to July 15, 2023. One hundred and fifty eight patients were randomly assigned to two groups: Group A (gum chewing) and Group B (control), each containing 79 patients. Group A was instructed to chew gum for 15 minutes three times a day starting 6 hours after surgery. Group B received conservative management, commencing clear oral fluids after the passage of gas and transitioning to a soft diet after passing stool. The primary outcome measures included the time to first bowel sounds, passage of flatus, passage of stool, and length of hospital stay, while secondary outcome measures comprised nausea, vomiting, patient satisfaction, and abdominal distension.
 Results: The average age in Group A was 48.6 ± 10.9, and in Group B it was 50.2 ± 13.7. The mean post-operative time (in hours) to audible bowel sounds in Group A and B was 49 (43-63) versus 61 (46-72), respectively (P=0.03); passage of flatus was 70 (50-83) versus 80 (67-110) (P=0.01); stool passage was (38.1 ± 29.8 versus 58.25 ± 18.6) (P=0.002); and hospital stay was 71 (56-89) versus 93 (75-118) (P<0.001).
 Conclusion: Gum chewing after elective abdomino-pelvic surgery enhances post-operative recovery by promoting early bowel function and thereby reducing hospital stays.