Effect of Gum-Chewing on Peristaltic Movement of the Gasterointestinal System after Laparatomic Appendectomy- a Randomized Clinical Trial

Document Type : Original Article

Authors

1 Associate Professor, Department of General Surgery, Hamadan University of Medical Sciences, Besat Hospital, Hamadan, Department of General Surgery

2 Pediatrics, Hamedan University of Medical Sciences and Health Services, Besat Hospital, Hamedan, Iran

3 General Physician and Researcher, Hamadan University of Medical Sciences, Besat Hospital, Hamadan, Department of General Surgery

Abstract
Introduction & Objective: Ileus is one of the common complications in hospitalized patients as well as it is the most common reason of delay in discharge from the hospital due to abdominal surgeries. Present study with aim of investigating the results of chewing gum on bowel movements of digestive system after appendectomy was designed. Materials & Methods: In this clinical trial using the related sample size formula 40 patients’ means that underwent appendectomy surgery in Besat- Hamedan Medical Center were randomly classified into the intervention and control groups (20 people per group). Inclusion criteria for the study included the age of over 15 and having appendectomy surgery and the exclusion criteria included hypothyroidism, hypo-parathyroid glands, electrolyte disorders, neuro muscular diseases and drug addiction. Method of anesthesia was similar in both groups. For the case group the chewing gum manufactured by the same factory and in the same flavor was prescribed within the four, ten and eighteen hours after the patient's recovery. No treatment was applied to the control group. One hour after the patient’s recovery and stabilization of the vital signs, the bowel sounds were examined by stethoscope by researcher in the case and control groups every two hours. The researcher evaluated flatulence and defecation by asking the patients. The collected data were analyzed by SPSS version 17 and the descriptive statistics were used in the required cases and the t-test was used for the evaluation of significance of the data. The significance level of data is considered lower than 0.05. Results: The average time to hear the first bowel sound in experimental group was 3.30 ± 1.17 hours and in control group it was 2.60 ± 1.23 hours. Therefore there was no significant difference (P = 0.073) between the experimental and control groups. The average time to gas-passing in experimental group was10.90 ± 3.52 hours and in control group it was 17.50 ± 9.90 hours that showed a significant difference (P = 0.008) between the experimental and control groups. Average time to defecation in the experimental group was 25.40 ± 5.03 hours and in control group it was 37.70 ± 13.98 hours. Therefore there was a significant difference (P = 0.001) between the experimental and control groups. The average time to receive oral feeding in the experimental group was 17.75 ± 4.88 hours and in control group it was 18.50 ± 5.18 hours (P = 0.641). The average time to leaving the sickbed in the experimental group was 8.85 ± 5.60 hours and in control group it was 10.55 ± 4.29 hours (P = 0.28). Conclusions: According to the results of this study, the average time to gas-passing and defecation in gum recipients group was significantly less than the control group. Complementary studies and finding ways to find out the chewing gum effects on reduction of Ileus time without questioning the patient about the first gas-passing and defecation after surgery was recommended.

Keywords


1. Bauer AJ, Boeckxstaens GE. Mechanisms of postoperative ileus. Neurogastroenterol Motil. 2004 Oct; 16 Suppl 2: 54-60. Review.
2. Boeckxstaens GE, de Jonge WJ. Neuroimmune mechanisms in postoperative ileus. Gut. 2009 Sep; 58(9): 1300-11. doi: 10.1136/gut. 2008. 169250. Review. Erratum in: Gut. 2010 Jan; 59(1): 140.
3. Person B, Wexner SD. The management of postoperative ileus. Curr Probl Surg. 2006 Jan; 43(1): 6-65. Review.
4. Behm B, Stollman N. Postoperative ileus: etiologies and interventions.Clin Gastroenterol Hepatol. 2003 Mar; 1(2): 71-80. Review.
5. De Jonge WJ, van den Wijngaard RM, The FO, ter Beek ML, Bennink RJ, Tytgat GN, Buijs RM, Reitsma PH, van Deventer SJ, Boeckxstaens GE. Postoperative ileus is maintained by intestinal immune infiltrates that activate inhibitory neural pathways in mice. Gastroenterology. 2003 Oct; 125(4): 1137-47.
6. Wehner S, Behrendt FF, Lyutenski BN, Lysson M, Bauer AJ, Hirner A, Kalff JC. Inhibition of macrophage function prevents intestinal inflammation and postoperative ileus in rodents.Gut. 2007 Feb; 56(2): 176-85.
7. Peters EG, De Jonge WJ, Smeets BJ, Luyer MD. The contribution of mast cells to postoperative ileus in experimental and clinical studies.Neurogastroenterol Motil. 2015 Jun; 27(6): 743-9. doi: 10.1111/nmo.12579. Review.
8. Craciunas L, Sajid MS, Ahmed AS. Chewing gum in preventing postoperative ileus in women undergoing caesarean section: a systematicreview and Meta analysis of randomized controlled trials. JOG. 2014 Jun; 121(7): 793-9; discussion 799.
9. Van Leersum NJ, Bonsing BA, Kroon HM, van der Sijp JR, van Weel V. [Chewing gum to prevent postoperative ileus].Ned Tijdschr Geneeskd. 2012; 156(22): A4794. Dutch.
10.    Vásquez W, Hernández AV, Garcia-Sabrido JL. Is gum chewing useful for ileus after elective colorectal surgery? A systematic review and meta-analysis of randomized clinical trials. J Gastrointest Surg. 2009 Apr; 13(4): 649-56.
11.    Noble EJ, Harris R, Hosie KB, Thomas S, Lewis SJ. Gum chewing reduces postoperative ileus? A systematic review and meta-analysis. Int J Surg. 2009 Apr; 7(2): 100-5.
12.    Safdari Dehcheshmeh F, Salehian T, Gangi F, Beigi M. The Effect of Chewing Sugar Free Gum after Elective Cesarean-Delivery on Return of Bowel Function in Primiparous Women. Qom Univ Med Sci J. 2011; 4 (4): 16-20.
13.    Safdari Dehcheshmeh F, Salehian T, Parvin N, Akbari N.  Comparison of the effects of gum chewing with those of early initiation of oral feeding and routine regimen on recovery of bowel function in primiparous women after cesarean section Scientific Journal of Kurdistan University of Med Sci. SJKu 2011, 16(2): 9-15.
14.    Mohsenzadeh Ledari F, Barat S, Nasiri Amiri F, Aghajani Delavar M, Banihosseini S, Khafri S. Effect of Gum Chewing after Cesarean-Delivery on Return of Bowel Function. JBUMS. 2012; 14 (3):
19-24.
15.    Pilehvarzadeh M, Shamsi A, Salari S, Rafeti F, Hosseinrezaii H, Ebadi A. Effect of gum chewing in the reduction of paralytic ileus following cholecystectomy. J Qazvin University Med Sci. 2014; 17 (6): 24-29.
16.    Abdollahi A A, yazdi K, Behnampur N, Neyaze M. The effect of chewing gum on bowel movements after appendectomy. Arak Medical University Journal. 2011; 13 (4): 38-43.
17.    Fogleman CD. Chewing Gum for Postoperative Recovery of Gastrointestinal Function. Am Fam Physician. 2015 Dec 1; 92(11): 974-5.
18.    Khadije Y, Abdollahi A A, Behnampour N, Niazi M, Arya B, Azadrah M. Effect of chewing gum on the bowel motility after cholecystectomy. ZJRMS. 2011; 13 (3): 24-20
19.    Ge W, Chen G, Ding YT. Effects of gum chewing on postoperative bowel motility after caesarean section: a meta-analysis of randomized controlled trials. Int J Clin Exp Med. 2015 Aug 15; 8(8):
11936-42. Review.
20.    Fogleman CD. Chewing gum for postoperative recovery of gastrointestinal function. Am Fam Physician. 2015 Dec 1; 92(11): 974-5.
21.    Huang HP, He M.Usefulness of chewing gum for recovering intestinal function after cesarean delivery: A systematic review and meta-analysis of randomized controlled trials. aiwan J Obstet Gynecol. 2015 Apr; 54(2): 116-21.
22.    Kobayashi T, Masaki T, Kogawa K, Matsuoka H, Sugiyama M. Efficacy of Gum Chewing on Bowel Movement after Open Colectomy for Left-Sided Colorectal Cancer: A Randomized Clinical Trial. Dis Colon Rectum. 2015 Nov; 58(11): 1058-63.
23.    Vergara-Fernandez O, Gonzalez-Vargas AP, Castellanos-Juarez JC, Salgado-Nesme N,
Sanchez-Garcia Ramos E. Usefulness of Gum Chewing to Decrease Postoperative Ileus in Colorectal Surgery with Primary Anastomosis: A Randomized Controlled Trial. Rev Invest Clin. 2016 Nov-Dec; 68(6): 314-318.
24.    Quah HM, Samad A, Neathey AJ, Hay DJ, Maw A.Does gum chewing reduce postoperative ileus following open colectomy for left-sided colon and rectal cancer? A prospective randomized controlled trial. Colorectal Dis. 2006 Jan; 8(1): 64-70.
25.    Atkinson C, Penfold CM, Ness AR, Longman RJ, Thomas SJ, Hollingworth W, Kandiyali R, Leary SD, Lewis SJ. Randomized clinical trial of postoperative chewing gum versus standard care after colorectal resection. Br J Surg. 2016 Jul; 103(8): 962-70. doi: 10.1002/bjs. 10194.