title: Effects of chewing gum against postoperative ileus after pancreaticoduodenectomy--a randomized controlled trial.
abstract: BACKGROUND
  Postoperative ileus is common after surgery. One non-pharmacological intervention that has shown promising results in reducing the duration of postoperative ileus is chewing gum after surgery. However, this has not been investigated in upper gastrointestinal surgery such as pancreatic surgery. Hence the aim of this study was to investigate the effects of chewing gum treatment on patients undergoing pancreaticoduodenectomy ad modum whipple due to pancreatic or periampullary cancer.
  
  
  METHODS
  This study was conducted as a phase III trial that was terminated early. Patients diagnosed with pancreatic tumours scheduled for pancreaticoduodenectomy ad modum whipple were included. The treatment group received chewing gum postoperatively and standard care. Controls received glucose solution and standard care. Chewing gum and glucose were used four times a day during the whole hospital stay. Time to first flatus and stool was defined as the primary outcome. The secondary outcome was start with clear liquids, start with liquid diet and length of hospital stay.
  
  
  RESULTS
  No statistically significant differences could be observed between the chewing gum intervention group and the control group. However, a numerical difference in mean time was observed in first flatus, first stool, start of clear fluids, and start of liquid diet and length of hospital stay in favour of the intervention group.
  
  
  CONCLUSIONS
  Although this study did not find statistically significant differences favouring the use of chewing gum for postoperative ileus, a positive trend was observed of a reduction of the impact of postoperative ileus among patients after pancreatic surgery. It also contributes valuable methodological experience that is important for future studies of chewing gum interventions during recovery after pancreatic surgery.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT02319512 , publication date 2014-12-17.
authors.affiliation: Department of Surgery, Sahlgrenska University Hospital, Gothenburg, S-41345, Sweden. thomas.k.andersson@vgregion.se.
authors.forename: Thomas
authors.initials: T
authors.lastname: Andersson
authors.affiliation: Division of Nursing Science, Department of Medical and Health Sciences, University of Linköping, Linköping, Sweden. kristofer.bjersa@liu.se.
authors.forename: Kristofer
authors.initials: K
authors.lastname: Bjerså
authors.affiliation: Institute of Health and Care Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden. kristin.falk@fhs.gu.se.
authors.forename: Kristin
authors.initials: K
authors.lastname: Falk
authors.affiliation: Department of Surgery, Sahlgrenska University Hospital, Gothenburg, S-41345, Sweden. monika.fagevik-olsen@vgregion.se.|Department of Physical Therapy, Sahlgrenska University Hospital, Gothenburg, Sweden. monika.fagevik-olsen@vgregion.se.|Department of Gastrosurgical Research and Education, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden. monika.fagevik-olsen@vgregion.se.
authors.forename: Monika Fagevik
authors.initials: MF
authors.lastname: Olsén
mesh_terms: D000368:Aged; D014670:Ampulla of Vater / Q000473:pathology / Q000601:surgery; D002638:Chewing Gum; D003138:Common Bile Duct Neoplasms / Q000473:pathology / Q000601:surgery; D003672:Defecation / Q000502:physiology; D019587:Dietary Supplements; D005260:Female; D006801:Humans; D045823:Ileus / Q000178:diet therapy* / Q000209:etiology / Q000517:prevention & control; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000473:pathology / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications; D011184:Postoperative Period
chemical_list: D002638:Chewing Gum