Effect of gum chewing on the recovery of gastrointestinal function in patients undergoing gynecological surgery: a systematic review and meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

YIN Yanan ^1,2 , REN Jianhua ^1,2 , LONG Derong ^1,2 , JIANG Nijie ^1,2 ,  OU Yanghua ^1,2

1. Department of Gynecological Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu 610041, P.R.China;
2. Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu 610041, P.R.China;

Corresponding?author：

OU Yanghua, Email: 674841889@qq.com

Keywords：

Gum chewing; Gastrointestinal function recovery; Gynecological surgery; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.202103168

Video：

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Objective To systematically review the effect and influence of gum chewing on the recovery of gastrointestinal function in gynecological patients after operation. Methods EBSCO, MEDLINE, Web of Science, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials of gum chewing on gastrointestinal function recovery in patients after gynecological surgery from inception to September 30^th, 2020. Two reviewers independently screened literature, extracted data and assessed risk bias of included studies. RevMan 5.3 software was then used to perform the meta-analysis. Results A total of 9 studies were included, involving 962 patients. Meta-analysis results showed that the time of first flatus (MD=–8.34, 95%CI –10.72 to –5.95, P<0.000 01), the time of first defecation (MD=–14.97, 95%CI –29.28 to –0.66, P<0.04), and the recovery time of bowel sounds (MD=–5.83, 95%CI –10.15 to –1.51, P=0.008) of gum chewing group was significantly shorter than that of the control group, and the incidence of abdominal distension was decreased after gynecological surgery (RR=0.24, 95%CI 0.08 to 0.74, P=0.01). According to the results of subgroup analysis, the time of first flatus of the gum chewing group was significantly shorter than that of the control group in laparoscopy (MD=–5.43, 95%CI –7.12 to –3.73, P<0.000 01), laparotomy (MD=–10.46, 95%CI –13.56 to –7.97, P<0.000 01) and abdominal surgery (MD=–10.64, 95%CI –13.01 to –8.26, P<0.000 01); the first defecation time after laparotomy (MD=–29.18, 95%CI –46.03 to –12.33, P=0.000 7), and abdominal surgery (MD=–14.24, 95%CI –24.27 to –4.21, P=0.005) in chewing gum group was significantly shorter than that in the control group; however, there was no significant difference in the laparoscopy group (MD=–2.97, 95%CI –12.94 to 7.00, P=0.56). Conclusions The systematic review and meta-analysis shows that gum chewing after gynecological surgery can shorten the time of first flatus, first defecation, and first bowel movement, and reduce the incidence of abdominal distension. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusions.

Citation： YIN Yanan, REN Jianhua, LONG Derong, JIANG Nijie, OU Yanghua. Effect of gum chewing on the recovery of gastrointestinal function in patients undergoing gynecological surgery: a systematic review and meta-analysis. Chinese Journal of Evidence-Based Medicine, 2021, 21(8): 936-941. doi: 10.7507/1672-2531.202103168 Copy

1.	Wind J, Hofland J, Preckel B, et al. Perioperative strategy in colonic surgery; LAparoscopy and/or FAst track multimodal management versus standard care (LAFA trial). BMC Surg, 2006, 6: 16.
2.	Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions (Version 5.0. 2). Available at: https://training.cochrane.org/handbook/archive/v5.0.2/.
3.	李威, 劉念, 張士泰, 等. 婦科惡性腫瘤經腹手術術后咀嚼口香糖對胃腸功能恢復的影響. 中華腫瘤防治雜志, 2016, 23(3): 198-202.
4.	賀騰, 李華鳳, 郭進, 等. 術前咀嚼口香糖對婦科腹腔鏡手術患者術后康復的影響. 華西醫學, 2019, 34(8): 917-920.
5.	譚燕萍, 唐欣慧. 咀嚼口香糖對促進婦科腹部手術后胃腸功能恢復的影響. 當代護士(專科版), 2011, (10): 47-48.
6.	顧衛華, 王賽莉, 陳俊敏, 等. 咀嚼口香糖對婦科腹腔鏡手術后胃腸功能恢復的影響. 中國繼續醫學教育, 2017, 9(12): 105-107.
7.	陳玲, 何恒君. 婦科惡性腫瘤經腹手術術后咀嚼口香糖對胃腸功能恢的影響分析. 養生保健指南, 2017, (4): 227, 137.
8.	劉友花. 早期咀嚼口香糖對婦科惡性腫瘤術后肛門排氣時間的影響. 醫學信息, 2013, (28): 178-179.
9.	Nanthiphatthanachai A, Insin P. Effect of chewing gum on gastrointestinal function recovery after surgery of gynecological cancer patients at Rajavithi Hospital: a randomized controlled trial. Asian Pac J Cancer Prev, 2020, 21(3): 761-770.
10.	Jernigan AM, Chen CC, Sewell C. A randomized trial of chewing gum to prevent postoperative ileus after laparotomy for benign gynecologic surgery. Int J Gynaecol Obstet, 2014, 127(3): 279-82.
11.	Gong Y, Zhang Q, Qiao L, et al. Xylitol gum chewing to achieve early postoperative restoration of bowel motility after laparoscopic surgery. Surg Laparosc Endosc Percutan Tech, 2015, 25(4): 303-306.
12.	Lunding JA, Nordstr?m LM, Haukelid AO, et al. Vagal activation by sham feeding improves gastric motility in functional dyspepsia. Neurogastroenterol Motil, 2008, 20(6): 618-624.
13.	Su'a BU, Hill AG. Perioperative use of chewing gum affects the inflammatory response and reduces postoperative ileus following major colorectal surgery. Evid Based Med, 2015, 20(5): 185-186.
14.	Ho YM, Smith SR, Pockney P, et al. A meta-analysis on the effect of sham feeding following colectomy: should gum chewing be included in enhanced recovery after surgery protocols? Dis Colon Rectum, 2014, 57(1): 115-126.
15.	Su'a BU, Pollock TT, Lemanu DP, et al. Chewing gum and postoperative ileus in adults: a systematic literature review and meta-analysis. Int J Surg, 2015, 14: 49-55.
16.	Noble EJ, Harris R, Hosie KB, et al. Gum chewing reduces postoperative ileus? A systematic review and meta-analysis. Int J Surg, 2009, 7(2): 100-105.
17.	Sanfilippo F, Spoletini G. Perspectives on the importance of postoperative ileus. Curr Med Res Opin, 2015, 31(4): 675-676.
18.	Johnson MD, Walsh RM. Current therapies to shorten postoperative ileus. Cleve Clin J Med, 2009, 76(11): 641-648.
19.	J?rgensen H, Wetterslev J, M?iniche S, et al. Epidural local anaesthetics versus opioid-based analgesic regimens on postoperative gastrointestinal paralysis, PONV and pain after abdominal surgery. Cochrane Database Syst Rev, 2000, (4): CD001893.
20.	Purkayastha S, Tilney HS, Darzi AW, et al. Meta-analysis of randomized studies evaluating chewing gum to enhance postoperative recovery following colectomy. Arch Surg, 2008, 143(8): 788-793.

1. Wind J, Hofland J, Preckel B, et al. Perioperative strategy in colonic surgery; LAparoscopy and/or FAst track multimodal management versus standard care (LAFA trial). BMC Surg, 2006, 6: 16.
2. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions (Version 5.0. 2). Available at: https://training.cochrane.org/handbook/archive/v5.0.2/.
3. 李威, 劉念, 張士泰, 等. 婦科惡性腫瘤經腹手術術后咀嚼口香糖對胃腸功能恢復的影響. 中華腫瘤防治雜志, 2016, 23(3): 198-202.
4. 賀騰, 李華鳳, 郭進, 等. 術前咀嚼口香糖對婦科腹腔鏡手術患者術后康復的影響. 華西醫學, 2019, 34(8): 917-920.
5. 譚燕萍, 唐欣慧. 咀嚼口香糖對促進婦科腹部手術后胃腸功能恢復的影響. 當代護士(專科版), 2011, (10): 47-48.
6. 顧衛華, 王賽莉, 陳俊敏, 等. 咀嚼口香糖對婦科腹腔鏡手術后胃腸功能恢復的影響. 中國繼續醫學教育, 2017, 9(12): 105-107.
7. 陳玲, 何恒君. 婦科惡性腫瘤經腹手術術后咀嚼口香糖對胃腸功能恢的影響分析. 養生保健指南, 2017, (4): 227, 137.
8. 劉友花. 早期咀嚼口香糖對婦科惡性腫瘤術后肛門排氣時間的影響. 醫學信息, 2013, (28): 178-179.
9. Nanthiphatthanachai A, Insin P. Effect of chewing gum on gastrointestinal function recovery after surgery of gynecological cancer patients at Rajavithi Hospital: a randomized controlled trial. Asian Pac J Cancer Prev, 2020, 21(3): 761-770.
10. Jernigan AM, Chen CC, Sewell C. A randomized trial of chewing gum to prevent postoperative ileus after laparotomy for benign gynecologic surgery. Int J Gynaecol Obstet, 2014, 127(3): 279-82.
11. Gong Y, Zhang Q, Qiao L, et al. Xylitol gum chewing to achieve early postoperative restoration of bowel motility after laparoscopic surgery. Surg Laparosc Endosc Percutan Tech, 2015, 25(4): 303-306.
12. Lunding JA, Nordstr?m LM, Haukelid AO, et al. Vagal activation by sham feeding improves gastric motility in functional dyspepsia. Neurogastroenterol Motil, 2008, 20(6): 618-624.
13. Su'a BU, Hill AG. Perioperative use of chewing gum affects the inflammatory response and reduces postoperative ileus following major colorectal surgery. Evid Based Med, 2015, 20(5): 185-186.
14. Ho YM, Smith SR, Pockney P, et al. A meta-analysis on the effect of sham feeding following colectomy: should gum chewing be included in enhanced recovery after surgery protocols? Dis Colon Rectum, 2014, 57(1): 115-126.
15. Su'a BU, Pollock TT, Lemanu DP, et al. Chewing gum and postoperative ileus in adults: a systematic literature review and meta-analysis. Int J Surg, 2015, 14: 49-55.
16. Noble EJ, Harris R, Hosie KB, et al. Gum chewing reduces postoperative ileus? A systematic review and meta-analysis. Int J Surg, 2009, 7(2): 100-105.
17. Sanfilippo F, Spoletini G. Perspectives on the importance of postoperative ileus. Curr Med Res Opin, 2015, 31(4): 675-676.
18. Johnson MD, Walsh RM. Current therapies to shorten postoperative ileus. Cleve Clin J Med, 2009, 76(11): 641-648.
19. J?rgensen H, Wetterslev J, M?iniche S, et al. Epidural local anaesthetics versus opioid-based analgesic regimens on postoperative gastrointestinal paralysis, PONV and pain after abdominal surgery. Cochrane Database Syst Rev, 2000, (4): CD001893.
20. Purkayastha S, Tilney HS, Darzi AW, et al. Meta-analysis of randomized studies evaluating chewing gum to enhance postoperative recovery following colectomy. Arch Surg, 2008, 143(8): 788-793.

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Effect of gum chewing on the recovery of gastrointestinal function in patients undergoing gynecological surgery: a systematic review and meta-analysis

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