Is gum chewing useful for ileus after elective colorectal surgery? A systematic review and meta-analysis of randomized clinical trials.
BACKGROUND
The evaluation of the usefulness of gum chewing for postoperative ileus has given inconclusive results. We evaluated the efficacy of gum chewing in the treatment of ileus after elective colorectal surgery.


METHODS
We performed a meta-analysis of randomized clinical trials comparing the effect of gum chewing+standard treatment vs. standard treatment on ileus after colorectal surgery. MEDLINE, EMBASE, the Cochrane Controlled Trial Register, and the Cochrane Database of Systematic Reviews were searched until August 2008. Primary outcomes were time to first flatus, time to first passage of feces, and length of hospital stay. The mean difference (MD) in hours was calculated with the random effects model to assess the effect of gum chewing on the outcomes.


RESULTS
Six trials including 244 patients were analyzed. Time to first flatus was significantly reduced with gum chewing+standard treatment compared to standard treatment alone (MD -14 h, 95% confidence interval [95%CI] -23.5 to -4.6). Time to first passage of feces was significantly reduced (MD -25 h, 95%CI -42.3 to -7.7), but the length of hospital stay was only marginally reduced (MD -26.2 h, 95%CI -57.5 to 5.2) with gum chewing.


CONCLUSIONS
In patients with ileus after colonic surgery, gum chewing in addition to standard treatment significantly reduces the time to first flatus and the time to first passage of feces when compared to standard treatment alone. There is also a trend to reduce the length of hospital stay. Gum chewing should be added to the standard treatment of these patients.
Vásquez
Wenceslao
W
Department of Surgery, Hospital Universitario Gregorio Marañón, Dr. Esquerdo 46, 28007, Madrid, Spain. tumi100@yahoo.com
Hernández
Adrián V
AV
Garcia-Sabrido
Jose Luis
JL
D002638:Chewing Gum; D003672:Defecation; D017558:Elective Surgical Procedures; D005414:Flatulence; D045823:Ileus / Q000517:prevention & control / Q000628:therapy*; D007902:Length of Stay; D011183:Postoperative Complications / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic
D002638:Chewing Gum