The Impact of Sham Feeding with Chewing Gum on Postoperative Ileus Following Colorectal Surgery: a Meta-Analysis of Randomised Controlled Trials

Farah Roslan,Anisa Kushairi,Laura Cappuyns,Prita Daliya,Alfred Adiamah

doi:10.1007/s11605-019-04507-3

Abstract

BackgroundChewing gum as a form of sham feeding is an inexpensive and well-tolerated means of promoting gastrointestinal motility following major abdominal surgery. Although recognised by the Enhanced Recovery After Surgery (ERAS) Society as one of the multimodal approaches to expedite recovery after surgery, strong evidence to support its use in routine postoperative practice is lacking. MethodologyA comprehensive literature review of all randomised controlled trials (RCTs) was performed in the Medline and Embase databases between 2000 and 2019. Studies were selected to compare the use of chewing gum versus standard care in the management of postoperative ileus (POI) in adults undergoing colorectal surgery. The primary outcome assessed was the incidence of POI. Secondary outcomes included time to passage of flatus, time to defecation, total length of hospital stay and mortality. ResultsSixteen RCTs were included in the systematic review, of which ten (970 patients) were included in the meta-analysis. The incidence of POI was significantly reduced in patients utilising chewing gum compared to those having standard care (RR 0.55, 95% CI 0.39, 0.79, p = 0.0009). These patients also had a significant reduction in time to passage of flatus (WMD − 0.31, 95% CI − 0.36, − 0.26, p < 0.00001) and time to defecation (WMD − 0.47, 95% CI − 0.60, − 0.34, p < 0.00001), without significant differences in the total length of hospital stay or mortality. ConclusionThe use of chewing gum after colorectal surgery is a safe and effective intervention in reducing the incidence of POI and merits routine use alongside other ERAS pathways in the postoperative setting.

Highlights

This paper was presented at the Society of Academic and Research Surgery and Royal Society of Medicine 2019 meeting
Qualitative analysis saw no significant difference in the incidence of postoperative ileus (POI) between the chewing gum and control groups.[12, 26]
It should be noted that this review included studies with paediatric patients, and patients undergoing gynaecological procedures, which might have affected the results. This meta-analysis of ten moderate to high quality randomised controlled trials (RCTs) provides evidence of the benefit of using sham feeding with chewing gum to reduce the incidence of POI in patients undergoing colorectal surgery

Summary

Introduction

This paper was presented at the Society of Academic and Research Surgery and Royal Society of Medicine 2019 meeting. Postoperative ileus (POI) is the temporary inhibition of gastrointestinal motility due to non-mechanical causes. After handling the bowel, it may result in nausea, vomiting and anorexia.[1] Despite the lack of standard clinical definitions, the incidence of POI is reported to occur in up to 1 in 4 patients who have undergone gastrointestinal surgery making POI arguably the most frequent complication following digestive surgery.[2, 3] Its sequelae include malnutrition, dehydration, electrolyte imbalance and aspiration pneumonia. Chewing gum as a form of sham feeding is an inexpensive and well-tolerated means of promoting gastrointestinal motility following major abdominal surgery. Studies were selected to compare the use of chewing gum versus standard care in the management of postoperative ileus (POI) in adults undergoing colorectal surgery. Secondary outcomes included time to passage of flatus, time to defecation, total length of hospital stay and mortality

Methods

Results

Discussion

Conclusion