title: Meta-analysis comparing chewing gum versus standard postoperative care after colorectal resection.
abstract: BACKGROUND
  Previous incomplete studies investigating the potential of chewing gum (CG) in patients undergoing colorectal resection did not obtain definitive conclusions. This updated meta-analysis was therefore conducted to evaluate the effect and safety of CG versus standard postoperative care protocols (SPCPs) after colorectal surgery.
  
  
  RESULTS
  Total 26 RCTs enrolling 2214 patients were included in this study. The CG can be well-tolerated by all patients. Compared with SPCPs, CG was associated with shorter time to first flatus (weighted mean difference (WMD) -12.14 (95 per cent c.i. -15.71 to -8.56) hours; P < 0.001), bowl movement (WMD -17.32 (-23.41 to -11.22) hours; P < 0.001), bowel sounds (WMD -6.02 (-7.42 to -4.63) hours; P < 0.001), and length of hospital stay (WMD -0.95 (-1.55 to -0.35) days; P < 0.001), a lower risk of postoperative ileus (risk ratio (RR) 0.61 (0.44 to 0.83); P = 0.002), net beneficial and quality of life. There were no significant differences between the two groups in overall complications, nausea, vomiting, bloating, wound infection, bleeding, dehiscence, readmission, reoperation, mortality.
  
  
  METHODS
  The potentially eligible randomized controlled trials (RCTs) that compared CG with SPCPs for colorectal resection were searched in PubMed, Embase, Cochrane library, China National Knowledge Infrastructure (CNKI), and Chinese Wanfang databases through May 2016. The trial sequential analysis was adopted to examine whether a firm conclusion for specific outcome can be drawn.
  
  
  CONCLUSIONS
  CG is benefit for enhancing return of gastrointestinal function after colorectal resection, and may be associated with lower risk of postoperative ileus.
authors: Department of Nursing, Tianjin Hospital, Tianjin 300211, China.
authors: Guo-Min
authors: GM
authors: Song
authors: School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China.
authors: Yong-Hong
authors: YH
authors: Deng
authors: School of Nursing, Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China.|Evidence-Based Nursing Center, Tianjin University of Traditional Chinese Medicine, Tianjin 300193, China.
authors: Ying-Hui
authors: YH
authors: Jin
authors: Department of Oncology, Affiliated Hospital of Zunyi Medical University, Zunyi 563000, China.
authors: Jian-Guo
authors: JG
authors: Zhou
authors: Department of Nursing, Chongqing Cancer Institute, Chongqing 400020, China.
authors: Xu
authors: X
authors: Tian
mesh_terms: D000328:Adult; D000368:Aged; D002638:Chewing Gum; D003107:Colorectal Surgery / Q000009:adverse effects; D005260:Female; D006801:Humans; D045823:Ileus / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications / Q000209:etiology
chemical_list: D002638:Chewing Gum
keywords: chewing gum; colorectal surgery; meta-analysis; postoperative ileus; trial sequential analysis