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August 18, 2008

Meta-analysis of Randomized Studies Evaluating Chewing Gum to Enhance Postoperative Recovery Following Colectomy

Author Affiliations

Author Affiliations: Department of Biosurgery and Surgical Technology, Imperial College London, St Mary's Hospital, London, England.

Arch Surg. 2008;143(8):788-793. doi:10.1001/archsurg.143.8.788

Objective  To compare outcomes following abdominal surgery with or without the use of chewing gum in the early postoperative period.

Data Sources  MEDLINE, Embase, Ovid, and Cochrane databases.

Study Selection  Randomized controlled trials reporting 1 or more outcomes related to functional postoperative recovery. Study quality was assessed using a validated scale.

Data Extraction  Time to the first passage of flatus, time to first bowel movement, and length of postoperative stay.

Data Synthesis  Five trials (158 patients) satisfied the inclusion criteria. Time (in days) for the patient to pass flatus (weighted mean difference [WMD], − 0.66; 95% confidence interval [CI], − 1.11 to − 0.20; P = .005) and the time until the first bowel movement (WMD, − 1.10; 95% CI, − 1.79 to − 0.42; P = .002) were significantly reduced in the chewing gum group compared with controls. However, both of these results demonstrated significant heterogeneity. Postoperative length of stay was also reduced in the chewing gum group by longer than 1 day (WMD, − 1.25; 95% CI, − 3.27 to 0.77; P = .23); however, this result was not statistically significant. This result was significant when studies that explicitly included patients with stomas being formed during the surgery were excluded (WMD, − 2.46; 95% CI, − 3.14 to − 1.79; P < .001), with no significant heterogeneity.

Conclusions  Chewing gum may enhance intestinal recovery following colectomy and reduce the length of hospital stay. Owing to the potential for substantial cost savings, larger-scale, blinded, randomized controlled trials with placebo arms are warranted.