Liu Q, et al. - Researchers aimed at conducting an updated meta-analysis to evaluate the efficacy of gum chewing in alleviating ileus following colorectal surgery. Current evidence suggested chewing gum as an inexpensive, well-tolerated, safe and effective method to ameliorate ileus following colorectal surgery. However, they recommend tightly controlled, randomized and considerably larger multicenter trials to further support the findings.

Methods

• PubMed, EMBASE, and Cochrane Library Databases were searched through February 2017 to identify randomized controlled trials (RCTs) evaluating the efficacy of the additional use of chewing gum following colorectal surgery.
• After screening for inclusion, researchers performed data extraction, and quality assessment meta-analysis by the Review Manager 5.3 software.
• The time to first flatus, time to first bowel movement, length of hospital stay, and some clinically relevant parameters were the outcomes of interest.
• Subgroup analyses in accordance to the type of surgical approaches or on trials that adopted enhanced recovery after surgery (ERAS) protocol or sugared gum were also performed.

Results

• This study included 18 RCTs, involving 1736 patients.
• In comparison with standardized postoperative care, Chewing gum led to a shorter passage to first flatus [WMD = -8.81, 95%CI: (-13.45, -4.17), P = 0.0002], earlier recovery of bowel movement [WMD = -16.43, 95%CI: (-22.68, -10.19), P
• In addition, Chewing gum seemed associated with a lower risk of postoperative ileus [OR = 0.41, 95%CI: (0.23, 0.73), P = 0.003].
• Researchers noticed no evidence of significant advantages in overall postoperative complication, nausea, vomiting, bloating, readmission and reoperation towards the addition of chewing gum.
• All subgroup analyses seemed favoring gum chewing.
• However, the significant heterogeneity between trials hampered the findings.