Role of Chewing Gum in Reducing Postoperative Ileus after Reversal of Ileostomy: A Randomized Controlled Trial

Reduction of postoperative ileus in gastrointestinal surgery: systematic review and meta-analysis

BACKGROUND

Postoperative ileus is a surgical complication that affects intestinal motility. There are measures to reduce this problem, but not all have conclusive evidence. This study aimed to determine which measures, such as coffee, chewing gum (CG), electroacupuncture (EA), daikenchuto (DKT), and prokinetic agents, are most effective in reducing postoperative ileus in patients undergoing gastrointestinal surgeries.

METHODS

A systematic search was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines on Google Scholar, PubMed, ScienceDirect, and Web of Science. The following measures were studied to define postoperative ileus: time to passage of the first flatus and time to passage of the first stool. The mean differences were determined by subgroup analyses.

RESULTS

Of 176 studies, 37 were selected for the systematic review, which involved 4647 patients. The reduction in time to passage of the first flatus was -18.33 h (95% CI, -26.46 to -10.20; P <.01) for EA, -5.83 h (95% CI, -9.40 to -2.26; P <.01) for DKT, -14.87 h (95% CI, -26.84 to -2.90; P =.01) for CG, and -1.90 h (95% CI, -8.28 to 4.48; P =.56) for coffee. The reduction in time to passage of the first stool was -32.27 h (95% CI, -39.28 to -25.26; P <.01) for prokinetic agents, -23.05 h (95% CI, -29.31 to -16.78; P <.01) for CG, -12.89 h (95% CI, -17.78 to -8.01; P <.01) for coffee, -19.76 h (95% CI, -32.79 to -6.72; P <.01) for EA, and -0.70 h (95% CI, -25.51 to 26.92; P =.96) for DKT.

CONCLUSION

The use of CG, EA, and prokinetic agents decreased the time to passage of the first flatus and time to passage of the first stool and indirectly reduced postoperative ileus.

Postoperative Ileus and Nonpharmacological Nursing Interventions for Colorectal Surgery: A Systematic Review

PURPOSE

This review evaluates nonpharmacological interventions for postoperative ileus (POI) prevention and treatment.

DESIGN

We systematically reviewed articles from various databases between January 2012 and February 2023 on POI prevention in colorectal surgery patients, emphasizing nursing interventions.

METHODS

Inclusion was based on criteria such as language (English or Turkish), date range, and study type. The risk of bias was evaluated using Cochrane's RoB2 tool.

FINDINGS

Of the 3,497 articles found, 987 unique articles were considered. After title and abstract reviews, 977 articles were excluded, leaving 52 randomized controlled trials for examination. Common interventions included chewing gum, early hydration, acupuncture, and coffee consumption. Compared to control groups, intervention groups had quicker bowel function return, shorter hospital stays, fewer complications, and enhanced quality of life.

CONCLUSION

Nondrug nursing interventions post colorectal surgery can effectively mitigate POI, optimize bowel function, and boost patient satisfaction, warranting their incorporation into post-surgery care protocols.

Comparison of the effect of chewing gum with routine method on ileus after burns: a randomized clinical trial

BACKGROUND

Chewing gum is a healthy, cheap, and familiar solution for patients with premature irritation of the stomach and intestines. This study compared the effect of chewing gum and the routine method on ileus after burns.

METHODS

This study is a randomized clinical trial conducted in Valiasr Hospital in Arak, Markazi Province, in the center of Iran, from December 2021 to February 2023. After the diagnosis of intestinal ileus in 83 patients hospitalized in the burn department by a general surgeon, with the available sampling method, these patients were evaluated based on the inclusion and exclusion criteria of the study. As a result, 66 patients were selected and divided into groups A (33 patients in the intervention group: routine care + gum chewing) and B (33 patients in the control group: routine care) by random allocation method. For the intervention group, from entering the ward until the beginning of oral feeding, gum (without sugar) was chewed four times a day for 15 min, while control groups received the routine diet of the department. Both groups' condition of the bowel sounds, time of passing gas, and stool were recorded. The statistical analyses were performed using SPSS version 16. The chi-squared, Fisher's exact, Independent t-test, and Mann-Whitney U tests were utilized.

RESULTS

The results showed that the median bowel sound return time, time of the first gas discharge, earliest defecation time, and time to start the diet were significantly shorter in the intervention group than in the control group (P < 0.001).

CONCLUSION

This study showed the effect of chewing gum without sugar in shortening the symptoms of intestinal ileus after burns. However, it was not effective in reducing the hospitalization period of patients. According to these results, it is recommended to add chewing gum to the routine care of people hospitalized due to burns.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials IRCT20180715040478N1, 2021-07-27.

Timing of Loop Ileostomy Closure Does Not Play a Pivotal Role in Terms of Complications-Results of the Liquidation of iLEOstomy (LILEO) Study

Loop ileostomy is commonly performed by colorectal and general surgeons to protect newly created large bowel anastomoses. The optimal timing for ileostomy closure remains debatable. Defining the timing associated with the best postoperative outcomes can significantly improve the clinical results for patients undergoing ileostomy closure. The LILEO study was a prospective multicenter cohort study conducted in Poland from October 2022 to December 2023. Full data analysis involved 159 patients from 19 surgical centers. Patients were categorized based on the timing of ileostomy reversal: early (<4 months), standard (4-6 months), and delayed (>6 months). Data on demographics, clinical characteristics, and perioperative outcomes were analyzed for each group separately and compared. No significant differences were observed in length of hospital stay (p = 0.22), overall postoperative complications (p = 0.43), or 30-day reoperation rates (p = 0.28) across the three groups. Additional analysis of Clavien-Dindo complication grades was performed and did not show significant differences in complication severity (p = 0.95), indicating that the timing of ileostomy closure does not significantly impact perioperative complications or hospital stay. Decisions on ileostomy reversal timing should be personalized and should consider individual clinical factors, including the type of adjuvant oncological treatment and the preventive measures performed for common postoperative complications.

Effect of chewing gum in reducing postoperative ileus after gastroduodenal perforation peritonitis surgery: A prospective randomised controlled trial

Chewing gum reduces the duration of postoperative ileus and early recovery of bowel function following elective abdominal surgery. However, its role has not been studied in cases of gastroduodenal perforation peritonitis, prompting us to conduct this study. Patients were randomised into two groups, 39 patients received chewing gum (study group) and 43 patients were in the control group. Sensation of hunger, appearance of first bowel sound, and passages of flatus and faeces were significantly early in the study group; their hospital stay was also shorter. Chewing gum reduces the duration of postoperative ileus in cases of gastroduodenal perforation peritonitis.Registration number: IEC/2020-23/3359 dated 13 December 2020, Institutional Ethics Committee, Netaji Subhash Chandra Bose Medical College, Jabalpur, India.

Effect evaluation of different preventive measures for ileus after abdominal operation: A systematic review and network meta-analysis

Background

Different approaches to the prevention of postoperative ileus have been evaluated in numerous randomized controlled trials. This network meta-analysis aimed to investigate the relative effectiveness of different interventions in preventing postoperative ileus.

Methods

Randomized controlled trials (RCTS) on the prevention of postoperative ileus were screened from Chinese and foreign medical databases and compared. STATA software was used for network meta-analysis using the frequency method. Random-effects network meta-analysis was also used to compare all schemes directly and indirectly.

Results

A total of 105 randomized controlled trials with 18,840 participants were included in this report. The results of the network meta-analysis showed that intravenous analgesia was most effective in preventing the incidence of postoperative ileus, the surface under the cumulative ranking curve (SUCRA) is 90.5. The most effective intervention for reducing the first postoperative exhaust time was postoperative abdominal mechanical massage (SUCRA: 97.3), and the most effective intervention for reducing the first postoperative defecation time was high-dose opioid antagonists (SUCRA: 84.3). Additionally, the most effective intervention for reducing the time to initiate a normal diet after surgery was accelerated rehabilitation (SUCRA: 85.4). A comprehensive analysis demonstrated the effectiveness and prominence of oral opioid antagonists and electroacupuncture (EA) combined with gum.

Conclusion

This network meta-analysis determined that oral opioid antagonists and EA combined with chewing gum are the most effective treatments and optimal interventions for reducing the incidence of postoperative ileus. However, methods such as abdominal mechanical massage and coffee require further high-quality research.

Risk factors of postoperative ileus following laparoscopic radical cystectomy and developing a points-based risk assessment scale

BACKGROUND

Postoperative ileus (POI) is one of the most common complications after laparoscopic radical cystectomy (LRC). Albeit its high incidence, its risk factors are obscure, and few studies have attempted to explore them. Meanwhile, risk-assessing tools for predicting its happening are lacking.

METHODS

Clinical data of 197 patients who underwent LRC between March 2014 and October 2019 were retrospectively collected. All cases of POI were identified and double-checked. Data pertaining to the following categories were extracted as well: patients' general characteristics, preoperative laboratory tests results and preparations, intraoperative and postoperative general items, pathological results. The correlation between candidate risk factors and ileus was analyzed by multivariable binary logistic regression. Clinical and pathophysiological explanations for those results were explored. Finally, a points-based prediction model was developed and validated for predicting the happening of POI.

RESULTS

A total of 63 out of 197 patients (31.98%) suffered from POI. Multivariate logistic regression analysis showed chronic constipation, increased dosage of laxative, elevated preoperative serum creatinine level, delayed postoperative ambulation, intestine-related urine derivations were statistically significant for developing POI (P<0.05). No significant differences were found between POI and age, gender, body mass index (BMI), antibiotics, hypertension, diabetes, smoking, hard-drinking, preoperative hemoglobin level, preoperative albumin level, history of previous abdominal surgery, surgery time, intraoperative blood loss, blood transfusion, tumor size, lymph nodes yields, TNM staging and intensive care unit hospitalization. An external cohort had been used for testing the validation of the assessment scale, and the results were promising.

CONCLUSIONS

Early recognition is of great importance in protecting vulnerable patients from developing POI, knowing the above-mentioned risk factors and using the assessment scale should help to screen them better. Cases from diverse backgrounds might contribute to a more accurate and complete scale.