Chewing gum and postoperative ileus in adults: A systematic literature review and meta-analysis

• Chewing gum is a safe and well tolerated method to reduce time to improve POI.
• The degree of improvement is small and of limited clinical significance.
• The role of chewing gum in ERAS is less clear.
• Patients in established POI may benefit from chewing gum.

IntroductionPost-operative ileus (POI) is a major problem following elective abdominal surgery. Several studies have been published investigating the use of chewing gum to reduce POI. These studies however, have produced variable results. Thus, there is currently no consensus on whether chewing gum should be widely instituted as a means to help reduce POI.MethodsWe performed a systematic literature review to evaluate whether the use of chewing gum post-operatively improves POI in abdominal surgery. A comprehensive review of the literature was conducted according to the guidelines in the PRISMA statement. The following databases were searched: MEDLINE, PUBMED, EMBASE, SCOPUS, Science Direct, CINAHL and the Cochrane Central Register of Controlled Trials. Clinical outcomes were extracted and meta-analysis was performed.ResultsThere were 1019 patients from 12 randomised controlled studies included in this review. Only one study was conducted in an Enhanced Recovery after Surgery (ERAS) environment. Seven of the twelve studies concluded that chewing gum reduced post-operative ileus. The remaining five studies found no clinical improvement.Overall, there was a small benefit in reducing time to flatus, and time to bowel motion, but no difference in the length of stay or complications.ConclusionChewing gum offers only a small benefit in reducing time to flatus and time to passage of bowel motion following abdominal surgery. This benefit is of limited clinical significance. Further studies should be conducted in a modern peri-operative care environment.