The Impact of Sham Feeding with Chewing Gum on Postoperative Ileus Following Colorectal Surgery: a Meta-Analysis of Rand
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ORIGINAL ARTICLE
The Impact of Sham Feeding with Chewing Gum on Postoperative Ileus Following Colorectal Surgery: a Meta-Analysis of Randomised Controlled Trials Farah Roslan 1,2 & Anisa Kushairi 1,2 & Laura Cappuyns 1,2 & Prita Daliya 1,2 & Alfred Adiamah 1,2 Received: 6 August 2019 / Accepted: 16 December 2019 # 2020 The Author(s)
Abstract Background Chewing 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. Methodology A 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. Results Sixteen 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. Conclusion The 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. Keywords Sham feeding . Chewing gum . Postoperative ileus . Colorectal surgery
Introduction This paper was presented at the Society of Academic and Research Surgery and Royal Society of Medicine 2019 meeting. The meeting abstract was published in the British Journal of Surgery (https://doi.org/ 10.1002/bjs.2019.106.issue-S3) Farah Roslan and Anisa Kushairi are joint first authors. * Alfred Adiamah [email protected] 1
Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen’s Medical Centre Campus, Derby Road, Nottingham NG7 2UH, UK
2
East Midlands Surgical Academic Network (EMSAN), Queen’s Medical Centre Campus, Derby Road, Nottingham NG7 2UH, UK
Postoperative ileus (POI) is the temporary inhibition of gastrointestinal motility due to non-mechanical causes. Occurring after abdominal surgery, particularly after handling the bowel, it may result in nau
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