title: Randomized clinical trial of chewing gum after laparoscopic colorectal resection.
abstract: BACKGROUND
  Chewing gum may enhance intestinal motility after surgery. This trial studied whether chewing gum could lead to a further reduction in ileus in patients who had a laparoscopic colorectal resection and followed an enhanced recovery programme.
  
  
  METHODS
  Patients undergoing laparoscopic colorectal resection were randomized to a control or intervention group. Patients in the control group received a standardized recovery programme. Patients in the intervention group were, in addition, given chewing gum three times daily from day 1 until discharge. Primary outcome measures were time to first flatus and first bowel motion. Time to feeling hungry and hospital stay were secondary outcome measures.
  
  
  RESULTS
  Forty-one patients were randomized into each group. Thirty-seven patients underwent rectal resection and 45 had a colonic resection. Time to passage of flatus was shorter (18 versus 34 h; P = 0·007), first bowel motion occurred earlier (19 versus 44 h; P = 0·001) and time to feeling hungry was earlier (16 versus 25 h; P = 0·001) in the intervention group. There was no difference in the duration of hospital stay (5 days in the intervention group versus 5·5 days in the control group). Subgroup analyses revealed that the benefits of chewing gum were clearer in patients who had a colonic resection, with a shorter time to first flatus (20 versus 35 h; P = 0·043), first bowel motion (19 versus 53 h; P = 0·014) and feeling hungry (14 versus 40 h; P = 0·001). No adverse events were attributed to chewing gum.
  
  
  CONCLUSIONS
  Chewing gum is a simple intervention that speeds intestinal transit in patients managed with a recovery programme after laparoscopic colorectal resection.
  
  
  BACKGROUND
  NCT02419586 (https://clinicaltrials.gov/).
authors.affiliation: Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong.
authors.forename: N F
authors.initials: NF
authors.lastname: Shum
authors.affiliation: Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong.
authors.forename: H K
authors.initials: HK
authors.lastname: Choi
authors.affiliation: Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong.
authors.forename: J C K
authors.initials: JC
authors.lastname: Mak
authors.affiliation: Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong.
authors.forename: D C C
authors.initials: DC
authors.lastname: Foo
authors.affiliation: Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong.
authors.forename: W C
authors.initials: WC
authors.lastname: Li
authors.affiliation: Department of Surgery, University of Hong Kong, Queen Mary Hospital, Hong Kong. lawwl@hkucc.hku.hk.
authors.forename: W L
authors.initials: WL
authors.lastname: Law
mesh_terms: D000368:Aged; D002638:Chewing Gum; D003106:Colon / Q000601:surgery*; D005260:Female; D005414:Flatulence / Q000503:physiopathology; D005772:Gastrointestinal Transit / Q000502:physiology; D006801:Humans; D006815:Hunger / Q000502:physiology; D045823:Ileus / Q000517:prevention & control; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control; D020127:Recovery of Function / Q000502:physiology; D012007:Rectum / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002638:Chewing Gum