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April 20, 2009

Sham-Feed or Sham?

Arch Surg. 2009;144(4):382. doi:10.1001/archsurg.2009.33

We read with interest the meta-analysis by Purkayastha et al1 on gum chewing and gut function in patients who have undergone colorectal surgery. We performed a similar meta-analysis of randomized controlled trials (RCTs)2 and recently updated it with an additional RCT.3 With the use of Comprehensive Meta-Analysis by Biostat (Biostat, Englewood, New Jersey), our updated meta-analysis included 6 RCTs and 256 patients (136 chewing gum; 120 controls). A random-effects model was used owing to significant study heterogeneity, and significant reductions in time to flatus and time to feces were identified, but we did not observe identifiable differences in hospital or postoperative complications as Purkayastha et al did. No complications were associated with gum chewing and only 1 patient failed to tolerate gum owing to ill-fitting dentures. Hence, gum chewing appears to be a very safe and well-tolerated option. However, while we applaud Purkayastha et al for clarifying the evidence base for gum chewing, in our understanding of the existing literature, we would question the value of additional larger studies on gum chewing.

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